Healthcare Provider Details

I. General information

NPI: 1548882053
Provider Name (Legal Business Name): RYAN MICHAEL KAYLOR DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38400 BOB WILSON DR
SAN DIEGO CA
92134-0001
US

IV. Provider business mailing address

38400 BOB WILSON DR
SAN DIEGO CA
92134-5000
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-6400
  • Fax:
Mailing address:
  • Phone: 619-532-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20A21453
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: