Individual provider Active NPI

John A Rybak, L.AC.

  • Acupuncturist
  • Portland, OR
National Provider Identifier
1639417900
Registry record updated May 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
AcupuncturistTaxonomy code 171100000X
License
AC161027 Issued in OR
Practice address
3059 NE Glisan St
Portland, OR 97232-3272
Phone
(503) 890-4446
NPI assigned
Jan 22, 2013
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 6, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acupuncturist 171100000X AC161027 OR Primary

Addresses

Primary practice location

3059 NE Glisan St
Portland, OR 97232-3272

Mailing address

3400 SE 75TH Ave
Portland, OR 97206-2408
Phone (503) 890-4446

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
AC161027ORMDAcupuncturist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1358812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1399334400000",
    "number": "1639417900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 SE 75TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972062408",
            "telephone_number": "503-890-4446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3059 NE GLISAN ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972323272",
            "telephone_number": "503-890-4446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYBAK",
        "first_name": "JOHN",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "credential": "L.AC.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-01-22",
        "last_updated": "2014-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "OR",
            "license": "AC161027",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.