Provider Demographics
NPI:1275978504
Name:CHURCH, RYAN THOMAS (MD)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:THOMAS
Last Name:CHURCH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1515 N VERMONT AVE
Mailing Address - Street 2:5TH FLOOR - DEPT OF DERMATOLOGY
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5337
Mailing Address - Country:US
Mailing Address - Phone:323-783-4171
Mailing Address - Fax:323-783-4171
Practice Address - Street 1:1515 N VERMONT AVE
Practice Address - Street 2:5TH FLOOR - DEPT OF DERMATOLOGY
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5337
Practice Address - Country:US
Practice Address - Phone:323-783-4171
Practice Address - Fax:323-783-4171
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA136859207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology