Healthcare Provider Details

I. General information

NPI: 1801013933
Provider Name (Legal Business Name): DR. KUKHWA RYU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 MING AVE
BAKERSFIELD CA
93309-4817
US

IV. Provider business mailing address

1500 GARFIELD AVE
SAN MARINO CA
91108-2324
US

V. Phone/Fax

Practice location:
  • Phone: 661-397-7400
  • Fax: 661-397-5639
Mailing address:
  • Phone: 661-397-7400
  • Fax: 714-571-3560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number55538
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: