Healthcare Provider Details

I. General information

NPI: 1326288382
Provider Name (Legal Business Name): HUKI RYU OMD,LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 03/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 WILSHIRE BLVD #915
LOS ANGELES CA
90010
US

IV. Provider business mailing address

3222 FAIRESTA ST #4
GLENDALE CA
91214-2606
US

V. Phone/Fax

Practice location:
  • Phone: 213-700-6346
  • Fax:
Mailing address:
  • Phone: 213-700-6346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number10645
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: