Provider Demographics
NPI:1720528128
Name:DAYDREAM ACUPUNCTURE, INC.
Entity Type:Organization
Organization Name:DAYDREAM ACUPUNCTURE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GAGIK
Authorized Official - Middle Name:
Authorized Official - Last Name:ISAHAKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:818-550-7860
Mailing Address - Street 1:600 W BROADWAY
Mailing Address - Street 2:SUITE 135
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-1022
Mailing Address - Country:US
Mailing Address - Phone:818-550-7860
Mailing Address - Fax:818-550-7861
Practice Address - Street 1:155 W HOSPITALITY LN
Practice Address - Street 2:SUITE 175
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3305
Practice Address - Country:US
Practice Address - Phone:818-550-7860
Practice Address - Fax:818-550-7861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6852171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1801986831OtherNPI