Provider Demographics
NPI:1821678376
Name:SURUJDIN, RYAN TEMAL
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:TEMAL
Last Name:SURUJDIN
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 1:3333 HARRY HINES BLVD APT 4133
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-6006
Mailing Address - Country:US
Mailing Address - Phone:469-212-2257
Mailing Address - Fax:
Practice Address - Street 1:424 HAHLO ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77020-3022
Practice Address - Country:US
Practice Address - Phone:713-674-3326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program