Provider Demographics
NPI:1225320583
Name:LUONG, RYAN (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:LUONG
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-4609
Mailing Address - Country:US
Mailing Address - Phone:316-686-5555
Mailing Address - Fax:316-686-3440
Practice Address - Street 1:907 E LINCOLN LN
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:KS
Practice Address - Zip Code:66030-3701
Practice Address - Country:US
Practice Address - Phone:913-856-1369
Practice Address - Fax:913-856-1368
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-37555207Q00000X
IAMD-43350207P00000X
TXV7749207Q00000X
CAC200896207Q00000X
HIMD-25144207Q00000X
MO2016014773207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201106000BMedicaid
MO200026663Medicaid