Provider Demographics
NPI:1568992345
Name:JORY, JESSE ELIJAH
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:ELIJAH
Last Name:JORY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2922 ROWENA AVE UNIT 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-2042
Mailing Address - Country:US
Mailing Address - Phone:424-333-1685
Mailing Address - Fax:
Practice Address - Street 1:2526 HYPERION AVE STE 3
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-3352
Practice Address - Country:US
Practice Address - Phone:424-333-1685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17486171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist