Provider Demographics
NPI:1902450364
Name:JISUN RYU ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:JISUN RYU ACUPUNCTURE LLC
Other - Org Name:BETHESDA METRO ACUPUNCTURE & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/LICENSED ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:JISUN
Authorized Official - Middle Name:
Authorized Official - Last Name:RYU
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:607-423-6393
Mailing Address - Street 1:4401 EAST WEST HWY
Mailing Address - Street 2:SUITE 404
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4401 E WEST HWY # 404
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814
Practice Address - Country:US
Practice Address - Phone:607-423-6393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JISUN RYU ACUPUNCTURE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-24
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty