Healthcare Provider Details

I. General information

NPI: 1578944690
Provider Name (Legal Business Name): RYU MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 06/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 E 4TH ST STE 138
SANTA ANA CA
92701-5143
US

IV. Provider business mailing address

1633 E 4TH ST STE 138
SANTA ANA CA
92701-5143
US

V. Phone/Fax

Practice location:
  • Phone: 714-543-4447
  • Fax: 714-543-4488
Mailing address:
  • Phone: 714-543-4447
  • Fax: 714-543-4488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberA25717
License Number StateCA

VIII. Authorized Official

Name: DR. CHUN K. RYU
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-543-4447