MEDICARE: RYU MEDICAL USA, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)	2014013941	GA

General Provider Information

NPI Number	:	1669886529
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RYU MEDICAL USA, INC.

Provider Business Mailing Address
First Line	:	3775 VENTURE DR BLDG N-202
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-5102
Country	:	US
Telephone Number	:	678-514-0648
Fax Number	:	770-817-6139

Provider Business Practice Location Address
First Line	:	3775 VENTURE DR BLDG N-202
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-5102
Country	:	US
Telephone Number	:	678-514-0648
Fax Number	:	770-817-6139

Authorized Official
Title or Position	:	GENERAL MANAGER
Name	:	MARCELL CHUN
Credential	:
Telephone Number	:	770-827-9801

Provider Enumeration Date	:	06/18/2014
Last Update Date	:	11/17/2014

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