Healthcare Provider Details

I. General information

NPI: 1275881435
Provider Name (Legal Business Name): RYAN SANGBUM HUR D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2012
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 W OLYMPIC BLVD SUITE 303
LOS ANGELES CA
90006-2518
US

IV. Provider business mailing address

2970 W OLYMPIC BLVD SUITE 303
LOS ANGELES CA
90006-2518
US

V. Phone/Fax

Practice location:
  • Phone: 213-388-4030
  • Fax: 213-388-4034
Mailing address:
  • Phone: 213-388-4030
  • Fax: 213-388-4034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number32347
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: