Provider Demographics
NPI:1578237061
Name:RYU, GEORGE KOUICHI (DPT)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:KOUICHI
Last Name:RYU
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13428 MAXELLA AVE # 115
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5620
Mailing Address - Country:US
Mailing Address - Phone:310-907-9215
Mailing Address - Fax:310-953-3281
Practice Address - Street 1:1015 PARK CIRCLE DR
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2817
Practice Address - Country:US
Practice Address - Phone:310-999-8107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299562261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy