Healthcare Provider Details

I. General information

NPI: 1407284888
Provider Name (Legal Business Name): CHI YOL RYU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2013
Last Update Date: 10/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 WILLOWBROOKE CIR
FRANKLIN TN
37069-7201
US

IV. Provider business mailing address

1431 WILLOWBROOKE CIR
FRANKLIN TN
37069-7201
US

V. Phone/Fax

Practice location:
  • Phone: 615-370-8903
  • Fax: 615-370-8903
Mailing address:
  • Phone: 615-370-8903
  • Fax: 615-370-8903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0000010551
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: