Healthcare Provider Details

I. General information

NPI: 1356031181
Provider Name (Legal Business Name): HYUNJAE RYU DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 04/29/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

458 HARTFORD RD
NEW BRITAIN CT
06053
US

IV. Provider business mailing address

1050 STATE ST APT 521
NEW HAVEN CT
06511-2778
US

V. Phone/Fax

Practice location:
  • Phone: 860-676-0050
  • Fax:
Mailing address:
  • Phone: 202-294-8346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number13869
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: