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General NPI Number Information
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NPI Number | 1073002507
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Entity Type | Individual
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Provider Name | KITAK RYU
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Gender | Male
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Dates
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Enumeration Date | 05/10/2018
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Last Update Date | 05/10/2018
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Provider Practice Location Address
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Address Line | 777 AVENUE C
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City | BAYONNE
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State | NJ
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Zip | 07002-2844
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Country | US
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Telephone | 201-436-0911
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Fax |
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Provider Business Mailing Address
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Address Line | 825 RAY AVE
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City | RIDGEFIELD
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State | NJ
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Zip | 07657
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Country | US
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Telephone | 201-615-8242
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 25MZ00130100
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License Number State | NJ
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