Provider Demographics
NPI:1467813766
Name:LUM GREEN, KRISTEN (LAC)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:LUM GREEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:LUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:18150 ANDREA CIR S UNIT 2
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-1159
Mailing Address - Country:US
Mailing Address - Phone:310-910-7308
Mailing Address - Fax:
Practice Address - Street 1:822 S ROBERTSON BLVD
Practice Address - Street 2:STE 300
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90035-2516
Practice Address - Country:US
Practice Address - Phone:424-235-7577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-14
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1185171100000X
CAAC17604171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist