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General NPI Number Information
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NPI Number | 1235351768
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Entity Type | Organization
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Legal Business Name | DIMITRI SIRAKOFF DO INC
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1206 E 17TH STREET SUITE 204
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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 | 714-835-3500
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Fax | 714-835-4619
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Provider Business Mailing Address
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Address Line | 1206 E 17TH STREET SUITE 204
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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 | 714-835-3500
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Fax | 714-835-4619
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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 | 714-835-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A5552
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License Number State | CA
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