Provider Demographics
NPI:1457575946
Name:FURUNJYAN, MARIA (DC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:FURUNJYAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 SANTA MONICA BLVD
Mailing Address - Street 2:#213
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-1252
Mailing Address - Country:US
Mailing Address - Phone:323-666-3221
Mailing Address - Fax:323-666-3221
Practice Address - Street 1:5250 SANTA MONICA BLVD
Practice Address - Street 2:#213
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1252
Practice Address - Country:US
Practice Address - Phone:323-666-3221
Practice Address - Fax:323-666-3221
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC21691111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1566528OtherPIN
CADC0216911Medicaid
U41981Medicare UPIN
CADC21691AMedicare ID - Type Unspecified