Provider Demographics
NPI:1659696409
Name:KURMANALIYEV, IDRIS K (LAC, MSAOM)
Entity Type:Individual
Prefix:
First Name:IDRIS
Middle Name:K
Last Name:KURMANALIYEV
Suffix:
Gender:M
Credentials:LAC, MSAOM
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4920 BARRANCA PKWY
Mailing Address - Street 2:D
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4672
Mailing Address - Country:US
Mailing Address - Phone:949-387-8422
Mailing Address - Fax:949-387-8423
Practice Address - Street 1:4920 BARRANCA PKWY
Practice Address - Street 2:D
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4672
Practice Address - Country:US
Practice Address - Phone:949-387-8422
Practice Address - Fax:949-387-8423
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC 13431171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist