Provider Demographics
NPI:1790827236
Name:INDERKUM, JOSEF OTHMAR (LAC)
Entity Type:Individual
Prefix:
First Name:JOSEF
Middle Name:OTHMAR
Last Name:INDERKUM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5018 NEVIN AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94805-2429
Mailing Address - Country:US
Mailing Address - Phone:510-234-0776
Mailing Address - Fax:
Practice Address - Street 1:6931 STOCKTON AVE
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-2931
Practice Address - Country:US
Practice Address - Phone:510-526-2412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5591171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist