Provider Demographics
NPI:1508142076
Name:DRAKE, JENNIFER HAUNANI CHONG (LAC, DIPLOM)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:HAUNANI CHONG
Last Name:DRAKE
Suffix:
Gender:F
Credentials:LAC, DIPLOM
Other - Prefix:
Other - First Name:HAUNANI
Other - Middle Name:
Other - Last Name:CHONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC, DIPL OM
Mailing Address - Street 1:PSC 851 BOX 1072
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09834-0011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PSC 851 BOX 1072
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09834
Practice Address - Country:US
Practice Address - Phone:202-375-9729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14433171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist