Healthcare Provider Details

I. General information

NPI: 1154749174
Provider Name (Legal Business Name): JOHN RYU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2014
Last Update Date: 01/24/2026
Certification Date: 01/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 W 12TH AVE
COLUMBUS OH
43210-1267
US

IV. Provider business mailing address

395 W 12TH AVE
COLUMBUS OH
43210-1267
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-8315
  • Fax: 614-293-6935
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35.127332
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number35.127332
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: