Healthcare Provider Details

I. General information

NPI: 1568297901
Provider Name (Legal Business Name): WONCHUNG MICHELLE RYU ACUPUNCTURIST, O.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2024
Last Update Date: 09/05/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

981 S. WESTERN AVE #301
LOS ANGELES CA
90006
US

IV. Provider business mailing address

981 S. WESTERN AVE #301
LOS ANGELES CA
90006
US

V. Phone/Fax

Practice location:
  • Phone: 323-643-4085
  • Fax:
Mailing address:
  • Phone: 323-301-8170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC13723
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: