Provider Demographics
NPI:1184650962
Name:GORDON, MAYUMI S (LAC)
Entity Type:Individual
Prefix:
First Name:MAYUMI
Middle Name:S
Last Name:GORDON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 10692
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91309-1692
Mailing Address - Country:US
Mailing Address - Phone:818-346-8888
Mailing Address - Fax:818-346-8889
Practice Address - Street 1:24335 VICTORY BLVD STE D
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307
Practice Address - Country:US
Practice Address - Phone:818-274-2125
Practice Address - Fax:818-436-2824
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC7875171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist