Provider Demographics
NPI:1053083162
Name:MA, RUIYA (LAC)
Entity type:Individual
Prefix:
First Name:RUIYA
Middle Name:
Last Name:MA
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 1:21718 20TH PL W
Mailing Address - Street 2:
Mailing Address - City:BRIER
Mailing Address - State:WA
Mailing Address - Zip Code:98036-8188
Mailing Address - Country:US
Mailing Address - Phone:305-915-5885
Mailing Address - Fax:
Practice Address - Street 1:21718 20TH PL W
Practice Address - Street 2:
Practice Address - City:BRIER
Practice Address - State:WA
Practice Address - Zip Code:98036-8188
Practice Address - Country:US
Practice Address - Phone:305-915-5885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC61212846171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist