Healthcare Provider Details

I. General information

NPI: 1730499799
Provider Name (Legal Business Name): SINA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2010
Last Update Date: 10/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 E 17TH ST STE N461
SANTA ANA CA
92701-2270
US

IV. Provider business mailing address

1125 E 17TH ST STE N461
SANTA ANA CA
92701-2270
US

V. Phone/Fax

Practice location:
  • Phone: 714-972-2200
  • Fax:
Mailing address:
  • Phone: 714-972-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC26980
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A6766
License Number StateKS

VIII. Authorized Official

Name: MRS. MANDANA MOUSAVI
Title or Position: PRESIDENT
Credential: D.C.
Phone: 714-972-2200