Provider Demographics
NPI:1043728041
Name:PARSI KANEMOTO, MARYAM
Entity Type:Individual
Prefix:
First Name:MARYAM
Middle Name:
Last Name:PARSI KANEMOTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARYAM
Other - Middle Name:
Other - Last Name:PARSI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:3001 JEFFREY DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-2928
Mailing Address - Country:US
Mailing Address - Phone:714-393-5245
Mailing Address - Fax:
Practice Address - Street 1:3001 JEFFREY DR UNIT A
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-2928
Practice Address - Country:US
Practice Address - Phone:714-393-5245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17884171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty