Healthcare Provider Details

I. General information

NPI: 1376056564
Provider Name (Legal Business Name): SIMON MA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E EMERSON AVE
MONTEREY PARK CA
91755
US

IV. Provider business mailing address

110 E EMERSON AVE
MONTEREY PARK CA
91755
US

V. Phone/Fax

Practice location:
  • Phone: 626-572-8002
  • Fax: 626-249-5394
Mailing address:
  • Phone: 626-572-8002
  • Fax: 626-249-5394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number33567
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: