MEDICARE: RYAN KU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	30280	TX

General Provider Information

NPI Number	:	1437558095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN KU

Provider Business Mailing Address
First Line	:	1138 FOREST HOME DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77077-1016
Country	:	US
Telephone Number	:	713-591-5434
Fax Number	:

Provider Business Practice Location Address
First Line	:	910 BOSTON POST RD
Second Line	:
City	:	WEST HAVEN
State	:	CT
Zip	:	06516-1845
Country	:	US
Telephone Number	:	203-934-3400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2014
Last Update Date	:	07/29/2020

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Directions to “ RYAN KU ” Practice Location

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