Healthcare Provider Details

I. General information

NPI: 1104633122
Provider Name (Legal Business Name): KIERA D LAYNE DACCHM, L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 E WALNUT ST STE 134
PASADENA CA
91101-1554
US

IV. Provider business mailing address

960 LARRABEE ST
WEST HOLLYWOOD CA
90069-3958
US

V. Phone/Fax

Practice location:
  • Phone: 626-377-9596
  • Fax:
Mailing address:
  • Phone: 631-478-3341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number20241
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: