Provider Demographics
NPI:1548601651
Name:RYU, JIN HYANG (ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:JIN HYANG
Middle Name:
Last Name:RYU
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 N KRAEMER BLVD STE 115
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-5050
Mailing Address - Country:US
Mailing Address - Phone:562-269-6122
Mailing Address - Fax:562-320-5812
Practice Address - Street 1:151 N KRAEMER BLVD STE 115
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870
Practice Address - Country:US
Practice Address - Phone:562-269-6122
Practice Address - Fax:562-320-5812
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 15496171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist