Provider Demographics
NPI:1265563290
Name:HYATT, GRIFFIN TROY (LAC)
Entity type:Individual
Prefix:MR
First Name:GRIFFIN
Middle Name:TROY
Last Name:HYATT
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 1:2120 4TH ST APT 24
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-2345
Mailing Address - Country:US
Mailing Address - Phone:310-396-1889
Mailing Address - Fax:
Practice Address - Street 1:1137 2ND ST STE 103
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5069
Practice Address - Country:US
Practice Address - Phone:310-395-5553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5643171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist