Healthcare Provider Details

I. General information

NPI: 1134879786
Provider Name (Legal Business Name): SALLY HEIRI RYU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEI RI RYU

II. Dates (important events)

Enumeration Date: 03/26/2022
Last Update Date: 03/26/2022
Certification Date: 03/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 PIERCE ST APT 12
SAN FRANCISCO CA
94115-3148
US

IV. Provider business mailing address

1635 PIERCE ST APT 12
SAN FRANCISCO CA
94115-3148
US

V. Phone/Fax

Practice location:
  • Phone: 949-545-3348
  • Fax:
Mailing address:
  • Phone: 949-545-3348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: