Provider Demographics
NPI:1740564368
Name:LAU, JENNIFER (LAC, LMT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:LAU
Suffix:
Gender:F
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66-216 FARRINGTON HIGHWAY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WAIALUA
Mailing Address - State:HI
Mailing Address - Zip Code:96791
Mailing Address - Country:US
Mailing Address - Phone:808-637-4880
Mailing Address - Fax:808-637-4880
Practice Address - Street 1:66-216 FARRINGTON HIGHWAY
Practice Address - Street 2:SUITE 202
Practice Address - City:WAIALUA
Practice Address - State:HI
Practice Address - Zip Code:96791
Practice Address - Country:US
Practice Address - Phone:808-637-4880
Practice Address - Fax:808-637-4880
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIACU 988171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist