Provider Demographics
NPI:1497102834
Name:RYU ACUPUNCTURE CLINIC, INC.
Entity Type:Organization
Organization Name:RYU ACUPUNCTURE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:RYU
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, PHD
Authorized Official - Phone:818-841-9790
Mailing Address - Street 1:3808 W RIVERSIDE DR
Mailing Address - Street 2:SUITE 510
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4325
Mailing Address - Country:US
Mailing Address - Phone:818-841-9790
Mailing Address - Fax:818-841-9092
Practice Address - Street 1:3808 W RIVERSIDE DR
Practice Address - Street 2:SUITE 510
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4325
Practice Address - Country:US
Practice Address - Phone:818-841-9790
Practice Address - Fax:818-841-9092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6016171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1679755185OtherNPI INDIVIDUAL PRACTITIONER