Provider Demographics
NPI:1154505568
Name:MAASSEN, JENS (LAC)
Entity Type:Individual
Prefix:
First Name:JENS
Middle Name:
Last Name:MAASSEN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 BLUEBELL DR
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-1332
Mailing Address - Country:US
Mailing Address - Phone:925-451-6282
Mailing Address - Fax:
Practice Address - Street 1:2330A SAN RAMON VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1608
Practice Address - Country:US
Practice Address - Phone:925-451-6282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA11907171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist