Basic Information
| Provider Information | |||||||||
| NPI: | 1881146264 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RYU | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | ASW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1310 WILSHIRE BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900171705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2134833000 | ||||||||
| FaxNumber: | 2133833146 | ||||||||
| Practice Location | |||||||||
| Address1: | 1310 WILSHIRE BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900171705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2134833000 | ||||||||
| FaxNumber: | 2133833146 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2016 | ||||||||
| LastUpdateDate: | 11/01/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | ASW71835 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.