Provider Demographics
NPI:1053379784
Name:ON, KIET A (D C)
Entity type:Individual
Prefix:
First Name:KIET
Middle Name:A
Last Name:ON
Suffix:
Gender:F
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15606 BROOKHURST ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-7582
Mailing Address - Country:US
Mailing Address - Phone:714-531-7730
Mailing Address - Fax:714-531-7793
Practice Address - Street 1:15606 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-7581
Practice Address - Country:US
Practice Address - Phone:714-531-7730
Practice Address - Fax:714-531-7793
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24912111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC24912Medicare ID - Type Unspecified