Provider Demographics
NPI:1043447303
Name:DANTIAN
Entity Type:Organization
Organization Name:DANTIAN
Other - Org Name:DANTIAN AT CHI THERAPY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:LICENSED ACUPUNCTURIST
Authorized Official - Prefix:MS
Authorized Official - First Name:DANTIAN
Authorized Official - Middle Name:TING
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:PHD,
Authorized Official - Phone:949-855-8948
Mailing Address - Street 1:24531 TRABUCO RD STE C
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-2162
Mailing Address - Country:US
Mailing Address - Phone:949-855-8948
Mailing Address - Fax:
Practice Address - Street 1:24531 TRABUCO RD STE C
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-2162
Practice Address - Country:US
Practice Address - Phone:949-855-8948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-15
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 18270111N00000X
CAAC 11888171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty