Provider Demographics
NPI:1679067003
Name:JIN, SERENA (DAOM LAC)
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:
Last Name:JIN
Suffix:
Gender:F
Credentials:DAOM LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 9TH ST
Mailing Address - Street 2:STE. B
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607
Mailing Address - Country:US
Mailing Address - Phone:415-988-0598
Mailing Address - Fax:
Practice Address - Street 1:320 10TH ST.
Practice Address - Street 2:STE 311
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607
Practice Address - Country:US
Practice Address - Phone:415-988-0598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-19
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18022171100000X
CAAC18022171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist