RIVER OF LIFE MEDICAL, LLC (NPI# 1710241245) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710241245 |
| Entity Type | Organization |
| Organization Name | RIVER OF LIFE MEDICAL, LLC |
| Practice Address |
1370 Dorchester Ave Ste 21 Dorchester MA 02122-2921 |
| Practice Telephone | 6175961092 |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2012-06-29 |
| Authorized Official Name | DR. DANIEL SANGHYUN CAGUA-KOO (OWNER) |
| Authorized Official Telephone | 6175961092 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP2300X |
Clinic/Center Specialization: Primary Care |
247965 | MA | Ambulatory Health Care Facilities |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Massachusetts Corporations | RIVER OF LIFE MEDICAL, LLC | 1370 Dorchester Ave., Ste 21, Dorchester, MA 02122 |
| Street Address |
1370 DORCHESTER AVE STE 21 |
| City | DORCHESTER |
| State | MA |
| Zip Code | 02122-2921 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033720875 | Joey Mark Nguyen | Pharmacist | 747 Gallivan Blvd, Dorchester, MA 02122 | 2020-08-14 |
| 1518575240 | Hamilton Pharmacy LLC | Pharmacy | 246 Bowdoin St, Dorchester, MA 02122 | 2020-07-20 |
| 1336789528 | Katheline Leconte | Social Worker | 230 Bowdoin Street, Dorchester, MA 02122 | 2020-01-15 |
| 1700374725 | Renee Ahern | Registered Nurse | 398 Neponset Ave., Dorchester, MA 02122 | 2018-04-25 |
| 1861902371 | Bridget Mary Walsh | Specialist/Technologist | 519 Ashmont St, Dorchester, MA 02122 | 2017-10-10 |
| 1649798133 | Roosevelt Lewis IIi | Registered Nurse | 1486 Dorchester Ave Ste 206, Boston, MA 02122 | 2017-09-05 |
| 1811427404 | Hanh Nguyen | Counselor | 50 Redfield St, Suite 300, Dorchester, MA 02122 | 2017-06-15 |
| 1669902474 | Thuy T Nguyen | Counselor | 415 Neponset Avenue, Dorchester, MA 02122 | 2017-06-14 |
| 1093262651 | David Scot Rapaport | Counselor | 1452 Dorchester Avenue, Fcbl-4, Boston, MA 02122 | 2016-09-01 |
| 1104372960 | Kevin Lyn Sisson | Student in an Organized Health Care Education/Training Program | 417 Neponset Ave, Boston, MA 02122 | 2016-08-31 |
| Find all providers in zip 02122 | ||||
| Taxonomy Code | 261QP2300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Primary Care |
| Definition to come... |
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|---|---|---|---|---|
| 1750789277 | Harvard Street Neighborhood Health Center | Clinic/Center | 632 Blue Hill Ave, Dorchester, MA 02121-3213 | 2014-12-16 |
| 1891053963 | Dorchester House Multi-service Center | Clinic/Center | 1353 Dorchester Ave, Dorchester, MA 02122-2932 | 2012-04-26 |
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| 1982102265 | Jacob Louis Perriello | Clinic/Center | 12 Drew Ave, Weymouth, MA 02189-2226 | 2018-02-01 |
| 1407385834 | Lawrence Health Solutions, LLC | Clinic/Center | 25 Marston St., Suite 105, Lawrence, MA 01841 | 2017-06-08 |
| 1962949925 | Regis College | Clinic/Center | 155 Wheeler Circle, Apt. 273, Stoughton, MA 02072 | 2017-01-27 |
| 1154866234 | Sokharith Mey, Md, Pllc | Clinic/Center | 280 Union St # 402, Lynn, MA 01901-1353 | 2016-12-28 |
| 1558721191 | Harbor Health Services Inc | Clinic/Center | 735 Attucks Lane, Hyannis, MA 02601 | 2016-02-24 |
| 1669830550 | Nirphemy Dambreville-lundy | Clinic/Center | 125 Gas Light Dr, 8, Weymouth, MA 02190-2142 | 2016-02-05 |
| 1891125480 | Western Massachusetts Primary Care PC | Clinic/Center | 405 Armory St, Springfield, MA 01104-2305 | 2013-11-18 |
| Find all providers with the same taxonomy | ||||
| City | DORCHESTER |
| Zip Code | 02122 |
Please comment or provide details below to improve the information on RIVER OF LIFE MEDICAL, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.