Provider Demographics
NPI:1447623467
Name:LOWY, JORDAN (LAC)
Entity type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:
Last Name:LOWY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 GUERRERO ST
Mailing Address - Street 2:APT 1
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-2975
Mailing Address - Country:US
Mailing Address - Phone:415-642-5683
Mailing Address - Fax:
Practice Address - Street 1:3490 20TH ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2582
Practice Address - Country:US
Practice Address - Phone:415-359-8532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-12
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC16426171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist