MEDICARE: URDAROMA LLC

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

General Provider Information

NPI Number	:	1689371643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	URDAROMA LLC

Provider Business Mailing Address
First Line	:	1958 NW COPPER OAKS CIR
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64015-8300
Country	:	US
Telephone Number	:	816-622-8496
Fax Number	:	816-295-1373

Provider Business Practice Location Address
First Line	:	1958 NW COPPER OAKS CIR
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64015-8300
Country	:	US
Telephone Number	:	816-622-8496
Fax Number	:	816-295-1373

Authorized Official
Title or Position	:	MEMBER
Name	:	JONG HO LEE
Credential	:
Telephone Number	:	913-702-7723

Provider Enumeration Date	:	02/10/2023
Last Update Date	:	02/10/2023

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