Provider Demographics
NPI:1164542999
Name:BAILEY, JAMES GRANT (LAC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:GRANT
Last Name:BAILEY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1522 MICHAEL LANE
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272
Mailing Address - Country:US
Mailing Address - Phone:310-393-4124
Mailing Address - Fax:310-393-4124
Practice Address - Street 1:1502 MONTANA AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-1855
Practice Address - Country:US
Practice Address - Phone:310-393-4124
Practice Address - Fax:310-393-4124
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6102171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist