Provider Demographics
NPI:1295947596
Name:RIEU, KEVIN Y (LAC)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:Y
Last Name:RIEU
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:MR
Other - First Name:YOUNG
Other - Middle Name:HA
Other - Last Name:YOO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1661 NEIL ARMSTRONG ST
Mailing Address - Street 2:#157
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640
Mailing Address - Country:US
Mailing Address - Phone:323-788-8733
Mailing Address - Fax:
Practice Address - Street 1:1661 NEIL ARMSTRONG ST
Practice Address - Street 2:#157
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640
Practice Address - Country:US
Practice Address - Phone:323-788-8733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11344171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist