Healthcare Provider Details

I. General information

NPI: 1609645035
Provider Name (Legal Business Name): RYU LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2023
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 PARK AVE
MOUNT AIRY MD
21771-5438
US

IV. Provider business mailing address

25925 LARGO CT
DAMASCUS MD
20872-2024
US

V. Phone/Fax

Practice location:
  • Phone: 301-703-8230
  • Fax: 301-703-8219
Mailing address:
  • Phone: 607-423-0452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JI WOON RYU
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 301-703-8230