Healthcare Provider Details

I. General information

NPI: 1912118886
Provider Name (Legal Business Name): SHARON ELAINE SKOK L. AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1067 N FAIRFAX AVE
WEST HOLLYWOOD CA
90046-6102
US

IV. Provider business mailing address

842 WESTBOURNE DR APT. 10
WEST HOLLYWOOD CA
90069-4624
US

V. Phone/Fax

Practice location:
  • Phone: 310-733-8455
  • Fax:
Mailing address:
  • Phone: 310-652-7939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC10239
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: