Healthcare Provider Details

I. General information

NPI: 1679094262
Provider Name (Legal Business Name): JIM KARLSSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 STANYAN ST APT 3
SAN FRANCISCO CA
94117-2747
US

IV. Provider business mailing address

830 STANYAN ST APT 3
SAN FRANCISCO CA
94117-2747
US

V. Phone/Fax

Practice location:
  • Phone: 805-252-1921
  • Fax:
Mailing address:
  • Phone: 805-252-1921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC17659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: