Provider Demographics
NPI:1184815284
Name:RYU, JENICA MAE KYUNGHI (MD)
Entity Type:Individual
Prefix:DR
First Name:JENICA
Middle Name:MAE KYUNGHI
Last Name:RYU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 S FREMONT AVE UNIT 22
Mailing Address - Street 2:BUILDING A-7, 4TH FLOOR, SUITE #7403
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-8847
Mailing Address - Country:US
Mailing Address - Phone:626-457-4226
Mailing Address - Fax:
Practice Address - Street 1:1000 S FREMONT AVE UNIT 22
Practice Address - Street 2:BUILDING A-7, 4TH FLOOR, SUITE #7403
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-8847
Practice Address - Country:US
Practice Address - Phone:626-457-4226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA99435207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine