Healthcare Provider Details

I. General information

NPI: 1558644765
Provider Name (Legal Business Name): YOONHWA KIM RYU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24140 ORCHARD LAKE RD
FARMINGTON HILLS MI
48336-2557
US

IV. Provider business mailing address

24140 ORCHARD LAKE RD
FARMINGTON HILLS MI
48336-2557
US

V. Phone/Fax

Practice location:
  • Phone: 248-888-9591
  • Fax:
Mailing address:
  • Phone: 248-888-9591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302034140
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: