River of Life Medical, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

247965 Issued in MA

Legal business name

RIVER OF LIFE MEDICAL, LLC

Practice address

1370 Dorchester Ave Ste 21
Dorchester, MA 02122-2921

Phone

(617) 596-1092

NPI assigned

Jun 29, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Daniel Sanghyun Cagua-Koo, M.D.

Title

Owner

Phone

(617) 596-1092

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1340928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340928000000",
    "number": "1710241245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1370 DORCHESTER AVE STE 21",
            "city": "DORCHESTER",
            "state": "MA",
            "postal_code": "021222921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1370 DORCHESTER AVE STE 21",
            "city": "DORCHESTER",
            "state": "MA",
            "postal_code": "021222921",
            "telephone_number": "617-596-1092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER OF LIFE MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-29",
        "last_updated": "2012-06-29",
        "status": "A",
        "authorized_official_last_name": "CAGUA-KOO",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "SANGHYUN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "617-596-1092",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MA",
            "license": "247965",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Rideout, PH.D.
• Eileen Ridge
• Chavely Rijo, RN
• Lauren Riley
• Delia Rissmiller, FNP-BC
• Deisy Rivera
• Gil Rivera
• Tia M Rivera
• Pragya Rizal, R.PH
• Cristina A Robalo

• Primary Care Clinic/Center in Dorchester, MA
• Providers in Dorchester, MA by specialty
• Primary Care Clinic/Center in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2012; 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.