Healthcare Provider Details

I. General information

NPI: 1437935772
Provider Name (Legal Business Name): JUYEON RYU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2023
Last Update Date: 09/04/2023
Certification Date: 09/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

753 N MCDONALD ST
MCKINNEY TX
75069-2139
US

IV. Provider business mailing address

701 LEGACY DR APT 524
PLANO TX
75023-2235
US

V. Phone/Fax

Practice location:
  • Phone: 469-526-1311
  • Fax:
Mailing address:
  • Phone: 214-629-4038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number39990
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: