Provider Demographics
NPI:1437491263
Name:JONES, KEVIN LANCE (LAC, OMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LANCE
Last Name:JONES
Suffix:
Gender:M
Credentials:LAC, OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 W IMPERIAL AVE
Mailing Address - Street 2:SUITE 88
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-2053
Mailing Address - Country:US
Mailing Address - Phone:310-344-9265
Mailing Address - Fax:310-648-8337
Practice Address - Street 1:3248 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2719
Practice Address - Country:US
Practice Address - Phone:310-334-9265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC1289171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist