Provider Demographics
NPI:1265148068
Name:RUIZ, KY TAI LE (AA, PA)
Entity type:Individual
Prefix:MRS
First Name:KY TAI
Middle Name:LE
Last Name:RUIZ
Suffix:
Gender:F
Credentials:AA, PA
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Other - Credentials:
Mailing Address - Street 1:1704 CREEK MILL TRCE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-6184
Mailing Address - Country:US
Mailing Address - Phone:404-384-8552
Mailing Address - Fax:
Practice Address - Street 1:1700 MEDICAL WAY
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2195
Practice Address - Country:US
Practice Address - Phone:770-979-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant