Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 20A5251 | CA |
NPI | 1164477410 |
---|---|
Provider Name | Thomas K Ryu |
First Address | Laguna Niguel, CA 92677 |
Second Address | Irvine, CA 92618-3714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 26/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00AX52510 | (05) | CA |
E81955 | (02) | CA |