Healthcare Provider Details

I. General information

NPI: 1477607711
Provider Name (Legal Business Name): DAYSTAR MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 E 17TH STREET SUITE 202
SANTA ANA CA
92701-2341
US

IV. Provider business mailing address

1206 E 17TH STREET SUITE 202
SANTA ANA CA
92701-2341
US

V. Phone/Fax

Practice location:
  • Phone: 714-619-2443
  • Fax: 714-619-2453
Mailing address:
  • Phone: 714-619-2443
  • Fax: 714-619-2453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DIMITRI SIRAKOFF
Title or Position: DO PRESIDENT
Credential: DO
Phone: 714-619-2443