Provider Demographics
NPI:1730249061
Name:MACKEY, DUANGJAI B (LAC)
Entity type:Individual
Prefix:
First Name:DUANGJAI
Middle Name:B
Last Name:MACKEY
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 1:4144 10TH ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-3110
Mailing Address - Country:US
Mailing Address - Phone:951-784-7578
Mailing Address - Fax:951-784-7578
Practice Address - Street 1:4144 10TH ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-3110
Practice Address - Country:US
Practice Address - Phone:951-784-7578
Practice Address - Fax:951-784-7578
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6410171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist