Healthcare Provider Details

I. General information

NPI: 1609531235
Provider Name (Legal Business Name): JEE YEON RYU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 W ALABAMA ST
HOUSTON TX
77098-2807
US

IV. Provider business mailing address

1 HERMANN PARK CT APT 434
HOUSTON TX
77021-2293
US

V. Phone/Fax

Practice location:
  • Phone: 713-807-7293
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number266612
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number39668
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: