=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346850757
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RYON ACUPUNCTURE CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2020
-----------------------------------------------------
Last Update Date | 08/11/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 151 YORBA ST STE 100
-----------------------------------------------------
City | TUSTIN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92780-2960
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-743-6570
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6428 SCHUBERT CIR
-----------------------------------------------------
City | BUENA PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90621-3126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-743-6570
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | RYON KIM
-----------------------------------------------------
Credential | LAC
-----------------------------------------------------
Telephone | 714-743-6570
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------