Provider Demographics
NPI:1831230945
Name:CONVEY, JOHN D (LAC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:CONVEY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:8430 SANTA MONICA BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-4265
Mailing Address - Country:US
Mailing Address - Phone:323-822-9030
Mailing Address - Fax:323-822-9033
Practice Address - Street 1:8430 SANTA MONICA BLVD STE 102
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-4265
Practice Address - Country:US
Practice Address - Phone:323-822-9030
Practice Address - Fax:323-822-9033
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 6498171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist