Provider Demographics
NPI:1427791193
Name:RYU, JUNGHEA (LAC)
Entity type:Individual
Prefix:
First Name:JUNGHEA
Middle Name:
Last Name:RYU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9709 KEY WEST AVE APT 408
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4522
Mailing Address - Country:US
Mailing Address - Phone:224-938-2851
Mailing Address - Fax:
Practice Address - Street 1:37 W 32ND ST FL 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3866
Practice Address - Country:US
Practice Address - Phone:718-225-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007056171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist