Provider Demographics
NPI:1639301922
Name:JOO, RYAN HYUN WOOK (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:HYUN WOOK
Last Name:JOO
Suffix:
Gender:M
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:PO BOX 1449
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92822-1449
Mailing Address - Country:US
Mailing Address - Phone:714-996-1633
Mailing Address - Fax:
Practice Address - Street 1:960 E GREEN ST STE 105
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2443
Practice Address - Country:US
Practice Address - Phone:626-304-0782
Practice Address - Fax:626-658-2848
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA114398207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA121320OtherMEDICARE / PTAN