Provider Demographics
NPI:1316701600
Name:DILLARD, KYONG-MI ROXANNE ARCALA (CMT)
Entity type:Individual
Prefix:
First Name:KYONG-MI
Middle Name:ROXANNE ARCALA
Last Name:DILLARD
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16761 VIEWPOINT LN APT 360
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-4788
Mailing Address - Country:US
Mailing Address - Phone:971-209-9821
Mailing Address - Fax:
Practice Address - Street 1:6480 E PACIFIC COAST HWY STE 150
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-4261
Practice Address - Country:US
Practice Address - Phone:562-451-4038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3199225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist