Healthcare Provider Details

I. General information

NPI: 1073054524
Provider Name (Legal Business Name): KUKHWA RYU DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2017
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 HARRIS ST
EUREKA CA
95503-4448
US

IV. Provider business mailing address

2045 REDWOOD ST
EUREKA CA
95503-8923
US

V. Phone/Fax

Practice location:
  • Phone: 714-808-3800
  • Fax:
Mailing address:
  • Phone: 714-808-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. KUKHWA RYU
Title or Position: PRESIDENT
Credential: DDS
Phone: 714-808-3800