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General NPI Number Information
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NPI Number | 1467813766
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Entity Type | Individual
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Provider Name | KRISTEN LUM GREEN LAC
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Gender | Female
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Dates
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Enumeration Date | 03/14/2016
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Last Update Date | 09/20/2021
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Provider Practice Location Address
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Address Line | 822 S ROBERTSON BLVD STE 300
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City | BEVERLY HILLS
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State | CA
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Zip | 90035-2516
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Country | US
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Telephone | 424-235-7577
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Fax |
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Provider Business Mailing Address
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Address Line | 18150 ANDREA CIR S UNIT 2
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City | NORTHRIDGE
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State | CA
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Zip | 91325-1159
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Country | US
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Telephone | 310-910-7308
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 1185
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC17604
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License Number State | CA
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