Provider Demographics
NPI:1407915945
Name:LUI, JENNIFER JEESIN (LAC)
Entity Type:Individual
Prefix:
First Name:JENNIFER JEESIN
Middle Name:
Last Name:LUI
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 1:435 N LARCHMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-3043
Mailing Address - Country:US
Mailing Address - Phone:323-973-0108
Mailing Address - Fax:213-254-9034
Practice Address - Street 1:435 N LARCHMONT BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-3043
Practice Address - Country:US
Practice Address - Phone:323-973-0108
Practice Address - Fax:213-254-9034
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9867171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist