Healthcare Provider Details

I. General information

NPI: 1538794714
Provider Name (Legal Business Name): YOUNGHEE VERONICA RYU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2020
Last Update Date: 03/07/2020
Certification Date: 03/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3808 W RIVERSIDE DR STE 510
BURBANK CA
91505-5301
US

IV. Provider business mailing address

3808 W RIVERSIDE DR STE 510
BURBANK CA
91505-5301
US

V. Phone/Fax

Practice location:
  • Phone: 909-802-6811
  • Fax:
Mailing address:
  • Phone: 909-802-6811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number18530
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: