Provider Demographics
NPI:1275075780
Name:OKUHAMA, JILL (DAOM, DIPL OM, LAC)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:
Last Name:OKUHAMA
Suffix:
Gender:F
Credentials:DAOM, DIPL OM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6162
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95056-6162
Mailing Address - Country:US
Mailing Address - Phone:818-810-8550
Mailing Address - Fax:
Practice Address - Street 1:151 87TH ST STE 4
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-1696
Practice Address - Country:US
Practice Address - Phone:650-757-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16925171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist