{
"Npi": {
"NPI": "1114066438",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "DAYSTAR MEDICAL CORPORATION",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1206 E 17TH STREET",
"SecondLineMailingAddress": "SUITE 202",
"MailingAddressCityName": "SANTA ANA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92701-2341",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "714-619-2443",
"MailingAddressFaxNumber": "714-619-2453",
"FirstLinePracticeLocationAddress": "954 W FOOTHILL BLVD",
"SecondLinePracticeLocationAddress": "#B",
"PracticeLocationAddressCityName": "UPLAND",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "91786-3713",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "714-619-2454",
"PracticeLocationAddressFaxNumber": "714-619-2453",
"EnumerationDate": "02/05/2007",
"LastUpdateDate": "09/11/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SIRAKOFF",
"AuthorizedOfficialFirstName": "DIMITRI",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DO",
"AuthorizedOfficialTelephoneNumber": "714-619-2443",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "111N00000X",
"TaxonomyName": "Chiropractor",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "171100000X",
"TaxonomyName": "Acupuncturist",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
]
}
}
}