Healthcare Provider Details

I. General information

NPI: 1669612800
Provider Name (Legal Business Name): KEUN YEONG RYU RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2009
Last Update Date: 02/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 AVENUE OF THE AMERICAS
NEW YORK NY
10019-4602
US

IV. Provider business mailing address

418 5TH AVE
RIVER EDGE NJ
07661-1219
US

V. Phone/Fax

Practice location:
  • Phone: 212-586-2740
  • Fax:
Mailing address:
  • Phone: 718-316-0091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number052276
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: