Healthcare Provider Details

I. General information

NPI: 1235049727
Provider Name (Legal Business Name): DJ SOMBOON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30231 GOLDEN LANTERN STE A
LAGUNA NIGUEL CA
92677-5989
US

IV. Provider business mailing address

214 CHANDON
LAGUNA NIGUEL CA
92677-5738
US

V. Phone/Fax

Practice location:
  • Phone: 949-779-0682
  • Fax:
Mailing address:
  • Phone: 949-779-0682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33248
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: