MEDICARE: DR. JAY JAEMYONG RYU L AC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC6016	CA

General Provider Information

NPI Number	:	1679755185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY JAEMYONG RYU L AC

Provider Business Mailing Address
First Line	:	3808 W RIVERSIDE DR
Second Line	:	SUITE 510
City	:	BURBANK
State	:	CA
Zip	:	91505-4325
Country	:	US
Telephone Number	:	818-841-9790
Fax Number	:	818-841-9092

Provider Business Practice Location Address
First Line	:	121 S GLENOAKS BLVD
Second Line	:	SUITE 1
City	:	BURBANK
State	:	CA
Zip	:	91502-1315
Country	:	US
Telephone Number	:	818-841-9790
Fax Number	:	818-841-9092

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2007
Last Update Date	:	04/22/2016

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