Provider Demographics
NPI:1184442907
Name:YAMASAKI-SANDERS, JESSIE REI (LAC, DATM)
Entity type:Individual
Prefix:DR
First Name:JESSIE
Middle Name:REI
Last Name:YAMASAKI-SANDERS
Suffix:
Gender:X
Credentials:LAC, DATM
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:REI
Other - Last Name:VANDENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4856 ROUND TOP DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-5230
Mailing Address - Country:US
Mailing Address - Phone:704-941-9440
Mailing Address - Fax:
Practice Address - Street 1:2945 ROWENA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-2003
Practice Address - Country:US
Practice Address - Phone:323-522-3822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-01
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC20188171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist