Healthcare Provider Details

I. General information

NPI: 1477200152
Provider Name (Legal Business Name): CHRISTINA SOOJUNG RYOU PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2022
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3816 WOODRUFF AVE STE 209
LONG BEACH CA
90808-2145
US

IV. Provider business mailing address

2526 ASSOCIATED RD APT 9
FULLERTON CA
92835-3240
US

V. Phone/Fax

Practice location:
  • Phone: 562-496-4749
  • Fax: 562-429-3329
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA67554
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: