Healthcare Provider Details

I. General information

NPI: 1508929506
Provider Name (Legal Business Name): HYUNG SUK RYU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 06/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 SAINT PAUL PL SIXTH FLOOR
BALTIMORE MD
21202-2001
US

IV. Provider business mailing address

227 SAINT PAUL PL SIXTH FLOOR
BALTIMORE MD
21202-2001
US

V. Phone/Fax

Practice location:
  • Phone: 410-332-9200
  • Fax: 410-783-5880
Mailing address:
  • Phone: 410-332-9200
  • Fax: 410-783-5880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberD68702
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD68702
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: