Provider Demographics
NPI:1063797488
Name:SCHOTHORST, JOHANNES HENDRIKUS JR (LAC)
Entity type:Individual
Prefix:MR
First Name:JOHANNES
Middle Name:HENDRIKUS
Last Name:SCHOTHORST
Suffix:JR
Gender:M
Credentials:LAC
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Mailing Address - Street 1:13252 GARDEN GROVE BLVD STE 112
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-2270
Mailing Address - Country:US
Mailing Address - Phone:714-740-1778
Mailing Address - Fax:714-740-1918
Practice Address - Street 1:13252 GARDEN GROVE BLVD STE 112
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-2270
Practice Address - Country:US
Practice Address - Phone:714-740-1778
Practice Address - Fax:714-740-1918
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
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Provider Licenses
StateLicense IDTaxonomies
CA14054171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist