Healthcare Provider Details

I. General information

NPI: 1548601651
Provider Name (Legal Business Name): JIN HYANG RYU ACUPUNCTURIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2013
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 N KRAEMER BLVD STE 115
PLACENTIA CA
92870
US

IV. Provider business mailing address

151 N KRAEMER BLVD STE 115
PLACENTIA CA
92870-5050
US

V. Phone/Fax

Practice location:
  • Phone: 562-269-6122
  • Fax: 562-320-5812
Mailing address:
  • Phone: 562-269-6122
  • Fax: 562-320-5812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 15496
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: