Provider Demographics
NPI:1346936952
Name:JOSEPHIAN, JENNY ADELE (LAC)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:ADELE
Last Name:JOSEPHIAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1442A WALNUT ST # 459
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-1405
Mailing Address - Country:US
Mailing Address - Phone:510-548-2261
Mailing Address - Fax:
Practice Address - Street 1:1502 WALNUT ST STE A
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709-1563
Practice Address - Country:US
Practice Address - Phone:510-548-2261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3347171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist