Ian James Clark, CMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

59748 Issued in CA

Practice address

26340 Camino de Vis Apt M
San Juan Capistrano, CA 92675-5123

Phone

(818) 224-8574

NPI assigned

Oct 24, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1666569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666569600000",
    "number": "1154048825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26340 CAMINO DE VIS APT M",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "926755123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26340 CAMINO DE VIS APT M",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "926755123",
            "telephone_number": "818-224-8574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "IAN",
        "middle_name": "JAMES",
        "credential": "CMT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-10-24",
        "last_updated": "2022-10-24",
        "certification_date": "2022-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "CA",
            "license": "59748",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Amornrat Chua, MFT
• Anna Seung-Eun Chung, DDS
• Julie Diane Chutuk, PPS
• Heather Cindric, M.D.
• Hilary Cisco Reuter, PH.D.
• Michael Clark, LMFT
• Virla Beatrice Clark, C.R.N.A.
• Darlene Clesceri
• Regina Lea Cline, MFT
• Coastal Infusions LLC

• Massage Therapist in San Juan Capistrano, CA
• Providers in San Juan Capistrano, CA by specialty
• Massage Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.