Dr. Hae Rim Ryu, DMD
Dentist, General Practice in San Diego, CA. Individual provider (NPI-1).
NPI number1982018909
StatusActive
Last updated in NPPESMay 4, 2026
Details
- NPI
- 1982018909
- Entity type
- Individual (NPI-1)
- Name
- Dr. Hae Rim Ryu
- Credential
- DMD
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jun 18, 2014
- Certification date
- May 4, 2026
- Last updated
- May 4, 2026
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · ORDER AND REFERRING ONLY - ORAL SURGERY
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility No · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | DDS101303 | CA | Yes |
| 1223G0001X | Dentist, General Practice | 30069 | TX |
Practice location
1060 University Ave Ste A201San Diego, CA 92103-7345
Phone 206-832-7702
Mailing address
1060 University Ave Ste A201San Diego, CA 92103-7345
Phone 206-832-7702
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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