Healthcare Provider Details

I. General information

NPI: 1225259609
Provider Name (Legal Business Name): MYUNG KIM RYANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HILLMONT AVE
VENTURA CA
93003-1651
US

IV. Provider business mailing address

800 S VICTORIA AVE, L4615 VCHCA - PHYSICIAN SERVICES
VENTURA CA
93009-0003
US

V. Phone/Fax

Practice location:
  • Phone: 805-652-6556
  • Fax:
Mailing address:
  • Phone: 805-677-5181
  • Fax: 805-677-5304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA33151
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA33151
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA33151
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: