Provider Demographics
NPI:1720348162
Name:YOSHIDA, RYU (MD)
Entity type:Individual
Prefix:
First Name:RYU
Middle Name:
Last Name:YOSHIDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 FARMINGTON AVE
Mailing Address - Street 2:MARB 4TH FLOOR
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032
Mailing Address - Country:US
Mailing Address - Phone:860-679-6679
Mailing Address - Fax:
Practice Address - Street 1:8635 W 3RD ST STE 990W
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6116
Practice Address - Country:US
Practice Address - Phone:310-423-5900
Practice Address - Fax:310-423-5940
Is Sole Proprietor?:No
Enumeration Date:2012-05-19
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA154889207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program