Provider Demographics
NPI:1326464850
Name:KUSNADI, FARAND (DC)
Entity Type:Individual
Prefix:
First Name:FARAND
Middle Name:
Last Name:KUSNADI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 E 17TH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3824
Mailing Address - Country:US
Mailing Address - Phone:949-999-0777
Mailing Address - Fax:949-999-0784
Practice Address - Street 1:230 E 17TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3824
Practice Address - Country:US
Practice Address - Phone:949-999-0777
Practice Address - Fax:949-999-0784
Is Sole Proprietor?:No
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC32009111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC 32009OtherDC LICENSE