Healthcare Provider Details

I. General information

NPI: 1235733072
Provider Name (Legal Business Name): YOUNG JOO RYU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6419 SKILLMAN ST
DALLAS TX
75231-7109
US

IV. Provider business mailing address

1851 KNIGHTSBRIDGE RD APT 4424
FARMERS BRANCH TX
75234-1353
US

V. Phone/Fax

Practice location:
  • Phone: 214-343-7418
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number61371
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: