Provider Demographics
NPI:1922211499
Name:KREVOY, HAL (LIC ACUPUNCTURIST)
Entity Type:Individual
Prefix:MR
First Name:HAL
Middle Name:
Last Name:KREVOY
Suffix:
Gender:M
Credentials:LIC ACUPUNCTURIST
Other - Prefix:
Other - First Name:HAL
Other - Middle Name:
Other - Last Name:KREVOY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:L,AC
Mailing Address - Street 1:1544 CARDIFF AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-3207
Mailing Address - Country:US
Mailing Address - Phone:310-770-7065
Mailing Address - Fax:
Practice Address - Street 1:1544 CARDIFF AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-3207
Practice Address - Country:US
Practice Address - Phone:310-770-7065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5387171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist