Provider Demographics
NPI:1598526329
Name:ACUGLO
Entity Type:Organization
Organization Name:ACUGLO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNNER
Authorized Official - Prefix:
Authorized Official - First Name:YOUNGHEE
Authorized Official - Middle Name:VERONICA
Authorized Official - Last Name:RYU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-802-6811
Mailing Address - Street 1:3808 W RIVERSIDE DR STE 510
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-5301
Mailing Address - Country:US
Mailing Address - Phone:909-802-6811
Mailing Address - Fax:
Practice Address - Street 1:3808 W RIVERSIDE DR STE 510
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-5301
Practice Address - Country:US
Practice Address - Phone:909-802-6811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center