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General NPI Number Information
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NPI Number | 1659877983
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Entity Type | Organization
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Legal Business Name | J BLACK ACUPUNCTURE INC
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Dates
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Enumeration Date | 04/04/2018
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Last Update Date | 04/04/2018
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Provider Practice Location Address
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Address Line | 5812 N FIGUEROA ST
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City | LOS ANGELES
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State | CA
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Zip | 90042-4228
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Country | US
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Telephone | 213-379-9347
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Fax |
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Provider Business Mailing Address
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Address Line | 6219 VIDETTE ST
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City | LOS ANGELES
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State | CA
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Zip | 90042-2132
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Country | US
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Telephone | 917-846-5270
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Fax |
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Authorized Official
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Title or Position | ACUPUNCTURIST
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Name | JENNIFER BLACK
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Credential | LAC
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Telephone | 213-379-9347
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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 | 16468
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License Number State | CA
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