Provider Demographics
NPI:1598940413
Name:THAIS-WILLIAMS, JEWEL (LAC)
Entity Type:Individual
Prefix:
First Name:JEWEL
Middle Name:
Last Name:THAIS-WILLIAMS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4073 W PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-4308
Mailing Address - Country:US
Mailing Address - Phone:323-733-0471
Mailing Address - Fax:323-733-6427
Practice Address - Street 1:4073 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-4308
Practice Address - Country:US
Practice Address - Phone:323-733-0471
Practice Address - Fax:323-733-6427
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2015-12-18
Deactivation Date:2012-10-24
Deactivation Code:
Reactivation Date:2015-12-18
Provider Licenses
StateLicense IDTaxonomies
CAAC6736171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist