MEDICARE: DR. DAVID KEUNJOO RYUMAN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	38153	CA

General Provider Information

NPI Number	:	1659586717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID KEUNJOO RYUMAN D.D.S.

Provider Business Mailing Address
First Line	:	2520 W 8TH ST STE 207
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-3861
Country	:	US
Telephone Number	:	213-386-3366
Fax Number	:	213-386-5669

Provider Business Practice Location Address
First Line	:	2520 W 8TH ST STE 207
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-3861
Country	:	US
Telephone Number	:	213-386-3366
Fax Number	:	213-386-5669

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	09/24/2020

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