Healthcare Provider Details

I. General information

NPI: 1396932182
Provider Name (Legal Business Name): NANCY KYUNG RYDER AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2007
Last Update Date: 09/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 PCH #5A
TORRANCE CA
90505-5948
US

IV. Provider business mailing address

3855 PCH #5A
TORRANCE CA
90505-5948
US

V. Phone/Fax

Practice location:
  • Phone: 310-375-3888
  • Fax: 310-375-3887
Mailing address:
  • Phone: 310-375-3888
  • Fax: 310-375-3887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC8904
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: