Provider Demographics
NPI:1215990767
Name:CHILKOV, JILL D (LAC, OMD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:D
Last Name:CHILKOV
Suffix:
Gender:F
Credentials:LAC, OMD
Other - Prefix:
Other - First Name:NALINI
Other - Middle Name:JILL
Other - Last Name:CHILKOV
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1158 26TH ST. SUITE 496
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403
Mailing Address - Country:US
Mailing Address - Phone:310-453-5700
Mailing Address - Fax:424-280-3014
Practice Address - Street 1:2428 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404
Practice Address - Country:US
Practice Address - Phone:310-453-5700
Practice Address - Fax:424-280-3014
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC2861171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC2861OtherACUPUNCTURE LICENSE