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General NPI Number Information
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NPI Number | 1114066438
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Entity Type | Organization
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Legal Business Name | DAYSTAR MEDICAL CORPORATION
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 954 W FOOTHILL BLVD #B
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City | UPLAND
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State | CA
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Zip | 91786-3713
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Country | US
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Telephone | 714-619-2454
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Fax | 714-619-2453
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Provider Business Mailing Address
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Address Line | 1206 E 17TH STREET SUITE 202
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City | SANTA ANA
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State | CA
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Zip | 92701-2341
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Country | US
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Telephone | 714-619-2443
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Fax | 714-619-2453
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Authorized Official
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Title or Position | PRESIDENT
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Name | DIMITRI SIRAKOFF
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Credential | DO
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Telephone | 714-619-2443
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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