Healthcare Provider Details

I. General information

NPI: 1316639917
Provider Name (Legal Business Name): KIAN MASOUMI RDHAP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 05/23/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31654 RANCHO VIEJO RD STE E
SAN JUAN CAPISTRANO CA
92675-6720
US

IV. Provider business mailing address

28002 MILT CIR
LAGUNA NIGUEL CA
92677-3779
US

V. Phone/Fax

Practice location:
  • Phone: 949-350-5426
  • Fax:
Mailing address:
  • Phone: 949-350-5426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: MRS. KIAN MASOUMI
Title or Position: CEO
Credential: DOCTORATE
Phone: 949-350-5426