Healthcare Provider Details

I. General information

NPI: 1578269601
Provider Name (Legal Business Name): MADELINE RYU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2023
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 E 31ST ST 2ND FLR A2
OAKLAND CA
94602-1018
US

IV. Provider business mailing address

1411 E 31ST ST 2ND FLR A2
OAKLAND CA
94602-1018
US

V. Phone/Fax

Practice location:
  • Phone: 510-437-5039
  • Fax: 510-535-7313
Mailing address:
  • Phone: 510-437-5039
  • Fax: 510-535-7313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: