Provider Demographics
NPI:1285241596
Name:DUNHAM, MARION JANE (LAC)
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:JANE
Last Name:DUNHAM
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 1:1048 EVERETT PL APT 3
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-4446
Mailing Address - Country:US
Mailing Address - Phone:415-632-8947
Mailing Address - Fax:
Practice Address - Street 1:3273 CASITAS AVE STE 106
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-2205
Practice Address - Country:US
Practice Address - Phone:415-632-8947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18936171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist