Healthcare Provider Details

I. General information

NPI: 1427791193
Provider Name (Legal Business Name): JUNGHEA RYU LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 W 32ND ST FL 4
NEW YORK NY
10001-3866
US

IV. Provider business mailing address

9709 KEY WEST AVE APT 408
ROCKVILLE MD
20850-4522
US

V. Phone/Fax

Practice location:
  • Phone: 718-225-9000
  • Fax:
Mailing address:
  • Phone: 224-938-2851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number007056
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: