Healthcare Provider Details

I. General information

NPI: 1902450364
Provider Name (Legal Business Name): JISUN RYU ACUPUNCTURE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 E WEST HWY # 404
BETHESDA MD
20814
US

IV. Provider business mailing address

4401 EAST WEST HWY SUITE 404
BETHESDA MD
20814
US

V. Phone/Fax

Practice location:
  • Phone: 607-423-6393
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JISUN RYU
Title or Position: OWNER/LICENSED ACUPUNCTURIST
Credential: L.AC
Phone: 607-423-6393