Provider Demographics
NPI:1912046285
Name:DAYSTAR MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DAYSTAR MEDICAL CORPORATION
Other - Org Name:DAYSTAR MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIMITRI
Authorized Official - Middle Name:
Authorized Official - Last Name:SIRAKOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:714-619-2443
Mailing Address - Street 1:1206 E 17TH STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-2341
Mailing Address - Country:US
Mailing Address - Phone:714-619-2443
Mailing Address - Fax:714-619-2453
Practice Address - Street 1:1206 E 17TH STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2341
Practice Address - Country:US
Practice Address - Phone:714-619-2443
Practice Address - Fax:714-619-2453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty