Healthcare Provider Details

I. General information

NPI: 1578237061
Provider Name (Legal Business Name): GEORGE KOUICHI RYU DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2021
Last Update Date: 08/06/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 PARK CIRCLE DR
TORRANCE CA
90502-2817
US

IV. Provider business mailing address

13428 MAXELLA AVE # 115
MARINA DEL REY CA
90292-5620
US

V. Phone/Fax

Practice location:
  • Phone: 310-999-8107
  • Fax:
Mailing address:
  • Phone: 310-907-9215
  • Fax: 310-953-3281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number299562
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: