Healthcare Provider Details

I. General information

NPI: 1790454288
Provider Name (Legal Business Name): HYEJIN RYU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 09/08/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 HUNTER LN
CAMP HILL PA
17011-2400
US

IV. Provider business mailing address

15710 SE PINE ST
PORTLAND OR
97233-3172
US

V. Phone/Fax

Practice location:
  • Phone: 800-748-3243
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number202109480RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: