Provider Demographics
NPI:1710420948
Name:DR. RYAN K. I. DAVIS, M.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DR. RYAN K. I. DAVIS, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:MIND HEALTH INSTITUTE, BEVERLY HILLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-988-9393
Mailing Address - Street 1:9777 WILSHIRE BLVD
Mailing Address - Street 2:#507
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-1910
Mailing Address - Country:US
Mailing Address - Phone:310-988-9393
Mailing Address - Fax:
Practice Address - Street 1:9777 WILSHIRE BLVD
Practice Address - Street 2:#507
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1910
Practice Address - Country:US
Practice Address - Phone:310-988-9393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-20
Last Update Date:2016-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1080352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty