MEDICARE: 5 STAR PRO CENTERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor		CA
2	174400000X	Specialist		CA

General Provider Information

NPI Number	:	1568827525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	5 STAR PRO CENTERS

Provider Business Mailing Address
First Line	:	1041 E YORBA LINDA BLVD STE 210
Second Line	:
City	:	PLACENTIA
State	:	CA
Zip	:	92870-3763
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1041 E YORBA LINDA BLVD STE 210
Second Line	:
City	:	PLACENTIA
State	:	CA
Zip	:	92870-3763
Country	:	US
Telephone Number	:	714-485-9332
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	NHU DANG
Credential	:
Telephone Number	:	714-485-9332

Provider Enumeration Date	:	12/17/2015
Last Update Date	:	12/17/2015

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