Provider Demographics
NPI:1356883102
Name:KARDOKAS-JOHANSON, RYDER VYTAUTAS (LAC)
Entity type:Individual
Prefix:
First Name:RYDER
Middle Name:VYTAUTAS
Last Name:KARDOKAS-JOHANSON
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:RYDER
Other - Middle Name:VYTAUTAS
Other - Last Name:JOHANSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:252 9TH ST ALY
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2095
Mailing Address - Country:US
Mailing Address - Phone:541-500-7233
Mailing Address - Fax:
Practice Address - Street 1:233 4TH ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2043
Practice Address - Country:US
Practice Address - Phone:541-500-7233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-10
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC180365171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist