Provider Demographics
NPI:1811088313
Name:LUBAN, JASON A (LAC)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:A
Last Name:LUBAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6114 LA SALLE AVE # 230
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-2802
Mailing Address - Country:US
Mailing Address - Phone:510-290-9393
Mailing Address - Fax:
Practice Address - Street 1:961 DEWING AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-4252
Practice Address - Country:US
Practice Address - Phone:925-283-3860
Practice Address - Fax:925-283-3860
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6124171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC6124OtherLICENSE NO