MEDICARE: DARIN T. RYUJIN PA

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	363A00000X	Physician Assistant	5396390-1206	UT
2	363AM0700X	Medical Physician Assistant	5396390-1206	UT

General Provider Information

NPI Number	:	1831289453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARIN T. RYUJIN PA

Provider Business Mailing Address
First Line	:	375 S CHIPETA WAY
Second Line	:	SUITE A200
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1260
Country	:	US
Telephone Number	:	801-581-2016
Fax Number	:

Provider Business Practice Location Address
First Line	:	375 S CHIPETA WAY
Second Line	:	A200
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1260
Country	:	US
Telephone Number	:	801-581-2016
Fax Number	:

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

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	11/17/2021

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