Healthcare Provider Details

I. General information

NPI: 1144422841
Provider Name (Legal Business Name): REN YI ZHI SHI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 05/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 HILLCREST AVE SUITE D
YORKVILLE IL
60560-1366
US

IV. Provider business mailing address

215 HILLCREST AVE SUITE D
YORKVILLE IL
60560-1366
US

V. Phone/Fax

Practice location:
  • Phone: 630-553-1783
  • Fax: 630-553-2951
Mailing address:
  • Phone: 630-553-1783
  • Fax: 630-553-2951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number198000531
License Number StateIL

VIII. Authorized Official

Name: MR. KURT REDMOND
Title or Position: ACUPUNCTURIST
Credential: L.AC.
Phone: 630-553-1783