Provider Demographics
NPI:1336476555
Name:WOOD, DAVID (LAC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:WOOD
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 1:4940 VAN NUYS BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1700
Mailing Address - Country:US
Mailing Address - Phone:818-990-8928
Mailing Address - Fax:818-990-9014
Practice Address - Street 1:4940 VAN NUYS BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1700
Practice Address - Country:US
Practice Address - Phone:818-990-8928
Practice Address - Fax:818-990-9014
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11029171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist