Individual
KATHLYN TAN JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MT
Contact information
Practice address
11770 WARNER AVE STE 123, FOUNTAIN VALLEY, CA 92708-2660
(714) 277-7169
Mailing address
617 ROSITA ST, SANTA ANA, CA 92703-2553
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
39797
CA
Other
Enumeration date
03/08/2021
Last updated
03/08/2021
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