Healthcare Provider Details

I. General information

NPI: 1912424862
Provider Name (Legal Business Name): JASON CHRISTIAN RYU PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3532 ALAMEDA DE LAS PULGAS
MENLO PARK CA
94025-6510
US

IV. Provider business mailing address

597 10TH AVE APT 2S
NEW YORK NY
10036-3090
US

V. Phone/Fax

Practice location:
  • Phone: 650-561-9589
  • Fax:
Mailing address:
  • Phone: 214-284-8072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number308027
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: