Provider Demographics
NPI:1003143645
Name:DYKSTRA, YIQUN (LAC)
Entity Type:Individual
Prefix:
First Name:YIQUN
Middle Name:
Last Name:DYKSTRA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:YIQUN
Other - Middle Name:
Other - Last Name:FU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:23232 PERALTA DR
Mailing Address - Street 2:STE 108
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1443
Mailing Address - Country:US
Mailing Address - Phone:949-334-0638
Mailing Address - Fax:
Practice Address - Street 1:23232 PERALTA DR
Practice Address - Street 2:STE 108
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1443
Practice Address - Country:US
Practice Address - Phone:949-334-0638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 13325171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist