Provider Demographics
NPI:1508824020
Name:DUNN, JAN PRESTON (LAC OMD DIPL AC)
Entity Type:Individual
Prefix:MS
First Name:JAN
Middle Name:PRESTON
Last Name:DUNN
Suffix:
Gender:F
Credentials:LAC OMD DIPL AC
Other - Prefix:MS
Other - First Name:JAN
Other - Middle Name:CAROLE
Other - Last Name:PRESTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC OMD DIPL AC
Mailing Address - Street 1:6117 LAURELGROVE AVE
Mailing Address - Street 2:
Mailing Address - City:N HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-4618
Mailing Address - Country:US
Mailing Address - Phone:818-762-1739
Mailing Address - Fax:
Practice Address - Street 1:22471 SUENO RD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2900
Practice Address - Country:US
Practice Address - Phone:818-222-5636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO570171100000X
CAAC2707171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist