Healthcare Provider Details

I. General information

NPI: 1720153497
Provider Name (Legal Business Name): BYUONG C RYU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 IRVING AVE SUITE 108
SYRACUSE NY
13210-1756
US

IV. Provider business mailing address

475 IRVING AVE #108
SYRACUSE NY
13210-1756
US

V. Phone/Fax

Practice location:
  • Phone: 315-671-0070
  • Fax: 315-475-0620
Mailing address:
  • Phone: 315-671-0070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number209295
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: