Provider Demographics
NPI:1518528280
Name:RYO, SUE KYUNG
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:KYUNG
Last Name:RYO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 E CHAPMAN AVE STE F
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-3955
Mailing Address - Country:US
Mailing Address - Phone:443-928-9948
Mailing Address - Fax:
Practice Address - Street 1:1351 E CHAPMAN AVE STE F
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-3955
Practice Address - Country:US
Practice Address - Phone:443-928-9948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC18002171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty