Provider Demographics
NPI:1154811354
Name:JOHNSON, LANA KATHLEEN (LAC)
Entity type:Individual
Prefix:
First Name:LANA
Middle Name:KATHLEEN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7270 W MANCHESTER AVE APT 618
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3853
Mailing Address - Country:US
Mailing Address - Phone:310-733-7927
Mailing Address - Fax:
Practice Address - Street 1:12240 VENICE BLVD STE 15A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-3891
Practice Address - Country:US
Practice Address - Phone:310-507-3296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA17666171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist