Healthcare Provider Details

I. General information

NPI: 1528168044
Provider Name (Legal Business Name): JEFFREY J RYU DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6389 N QUAIL HOLLOW RD STE 202
MEMPHIS TN
38120-1427
US

IV. Provider business mailing address

6389 N QUAIL HOLLOW RD STE 202
MEMPHIS TN
38120-1427
US

V. Phone/Fax

Practice location:
  • Phone: 901-767-3950
  • Fax:
Mailing address:
  • Phone: 901-767-3950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS07850
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: