Healthcare Provider Details

I. General information

NPI: 1245512607
Provider Name (Legal Business Name): MR. FRANK GISANG RYU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2011
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14795 JEFFREY RD SUITE 202
IRVINE CA
92618-0414
US

IV. Provider business mailing address

14795 JEFFREY RD SUITE 202
IRVINE CA
92618-0414
US

V. Phone/Fax

Practice location:
  • Phone: 949-398-7315
  • Fax: 949-398-7314
Mailing address:
  • Phone: 949-398-7315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA7668
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: