Provider Demographics
NPI:1912424862
Name:RYU, JASON CHRISTIAN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:CHRISTIAN
Last Name:RYU
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:597 10TH AVE APT 2S
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-3090
Mailing Address - Country:US
Mailing Address - Phone:214-284-8072
Mailing Address - Fax:
Practice Address - Street 1:3532 ALAMEDA DE LAS PULGAS
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-6510
Practice Address - Country:US
Practice Address - Phone:650-561-9589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-22
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA308027225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist