Healthcare Provider Details

I. General information

NPI: 1649546292
Provider Name (Legal Business Name): JACOB MICHAEL CHINN L.AC, MSTCM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1756 LACASSIE AVE SUITE 102
WALNUT CREEK CA
94596-7098
US

IV. Provider business mailing address

1756 LACASSIE AVE SUITE 102
WALNUT CREEK CA
94596-7098
US

V. Phone/Fax

Practice location:
  • Phone: 925-939-0300
  • Fax:
Mailing address:
  • Phone: 925-939-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC13669
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: