Provider Demographics
NPI:1679723654
Name:DIMITRI SIRAKOFF, D.O., INC.
Entity Type:Organization
Organization Name:DIMITRI SIRAKOFF, D.O., INC.
Other - Org Name:SANTA ANA HEALTH GROUP AND MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:
Authorized Official - Last Name:SILLASEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-835-3500
Mailing Address - Street 1:1206 E 17TH STREET
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-2341
Mailing Address - Country:US
Mailing Address - Phone:714-835-3500
Mailing Address - Fax:714-835-4619
Practice Address - Street 1:1206 E 17TH STREET
Practice Address - Street 2:SUITE 205
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2341
Practice Address - Country:US
Practice Address - Phone:714-835-3500
Practice Address - Fax:714-835-4619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3734171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty