Healthcare Provider Details

I. General information

NPI: 1376286971
Provider Name (Legal Business Name): JAMIE KRISTEN KULJIS DACM, L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2022
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 ATLANTIC AVE STE A10
LONG BEACH CA
90807-2245
US

IV. Provider business mailing address

4425 ATLANTIC AVE STE A10
LONG BEACH CA
90807-2245
US

V. Phone/Fax

Practice location:
  • Phone: 310-720-3062
  • Fax:
Mailing address:
  • Phone: 562-550-0925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number19399
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: