Provider Demographics
NPI:1881270528
Name:RYVKIN, BRANDON K
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:K
Last Name:RYVKIN
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 1:14271 DICKENS ST UNIT 201
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-5801
Mailing Address - Country:US
Mailing Address - Phone:818-284-1189
Mailing Address - Fax:
Practice Address - Street 1:14271 DICKENS ST UNIT 201
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-5801
Practice Address - Country:US
Practice Address - Phone:818-284-1189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program