Healthcare Provider Details

I. General information

NPI: 1912424151
Provider Name (Legal Business Name): HANKYUNG ANGELA RYU LCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 01/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4419 3RD AVE
BRONX NY
10457-2562
US

IV. Provider business mailing address

4419 3RD AVE
BRONX NY
10457-2562
US

V. Phone/Fax

Practice location:
  • Phone: 718-364-7700
  • Fax:
Mailing address:
  • Phone: 646-250-3346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number001772
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: