Provider Demographics
NPI:1497948426
Name:HONG, RYEO BONG (L AC)
Entity Type:Individual
Prefix:
First Name:RYEO BONG
Middle Name:
Last Name:HONG
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 S MONROE ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-5108
Mailing Address - Country:US
Mailing Address - Phone:408-261-0670
Mailing Address - Fax:408-261-8290
Practice Address - Street 1:344 S MONROE ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-5108
Practice Address - Country:US
Practice Address - Phone:408-261-0670
Practice Address - Fax:408-261-8290
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC10168171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist