Healthcare Provider Details

I. General information

NPI: 1457716656
Provider Name (Legal Business Name): MISS THAORN KRASAEYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13746 VICTORY BLVD STE 106
VAN NUYS CA
91401-6717
US

IV. Provider business mailing address

15149 SAN JOSE ST
MISSION HILLS CA
91345-2526
US

V. Phone/Fax

Practice location:
  • Phone: 818-428-9993
  • Fax:
Mailing address:
  • Phone: 818-898-2112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC16813
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: