Provider Demographics
NPI:1437558095
Name:KU, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:KU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 FOREST HOME DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-1016
Mailing Address - Country:US
Mailing Address - Phone:713-591-5434
Mailing Address - Fax:
Practice Address - Street 1:910 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-1845
Practice Address - Country:US
Practice Address - Phone:203-934-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-20
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30280122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist