Provider Demographics
NPI:1336741685
Name:HEYNE, ALEXANDER (DSOM, LAC)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:HEYNE
Suffix:
Gender:M
Credentials:DSOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 N LARCHMONT BLVD APT 206
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-1315
Mailing Address - Country:US
Mailing Address - Phone:203-609-3412
Mailing Address - Fax:
Practice Address - Street 1:1445 N GARDNER ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-4101
Practice Address - Country:US
Practice Address - Phone:203-609-3412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18975171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist