Healthcare Provider Details

I. General information

NPI: 1619488160
Provider Name (Legal Business Name): MS. KIJUNG RYU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 10/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 W 35TH ST FL 16
NEW YORK NY
10001-1907
US

IV. Provider business mailing address

253 W 35TH ST FL 16
NEW YORK NY
10001-1907
US

V. Phone/Fax

Practice location:
  • Phone: 718-728-8476
  • Fax:
Mailing address:
  • Phone: 718-728-8476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: