Healthcare Provider Details

I. General information

NPI: 1497102834
Provider Name (Legal Business Name): RYU ACUPUNCTURE CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2016
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3808 W RIVERSIDE DR SUITE 510
BURBANK CA
91505-4325
US

IV. Provider business mailing address

3808 W RIVERSIDE DR SUITE 510
BURBANK CA
91505-4325
US

V. Phone/Fax

Practice location:
  • Phone: 818-841-9790
  • Fax: 818-841-9092
Mailing address:
  • Phone: 818-841-9790
  • Fax: 818-841-9092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC6016
License Number StateCA

VIII. Authorized Official

Name: JAY RYU
Title or Position: OWNER
Credential: L.AC, PH.D.
Phone: 818-841-9790