Provider Demographics
NPI:1811401565
Name:CHEN, JAYNE SAMMOOL (LAC)
Entity Type:Individual
Prefix:
First Name:JAYNE
Middle Name:SAMMOOL
Last Name:CHEN
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 1:330 TOWNSEND ST STE 232
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-1659
Mailing Address - Country:US
Mailing Address - Phone:415-638-9399
Mailing Address - Fax:
Practice Address - Street 1:330 TOWNSEND ST STE 232
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-1659
Practice Address - Country:US
Practice Address - Phone:415-638-9399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-16
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17810171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist