1457278061 NPI number — CLARA SEOYEUN RYU MD

Table of content: CLARA SEOYEUN RYU MD (NPI 1457278061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457278061 NPI number — CLARA SEOYEUN RYU MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RYU
Provider First Name:
CLARA
Provider Middle Name:
SEOYEUN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457278061
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/03/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 EXECUTIVE PARK WEST NE
Provider Second Line Business Mailing Address:
UNIT 443 CORTLAND OLEANDER EAST
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30329-2223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-986-7210
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1364 CLIFTON RD NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30322-1059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-712-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/03/2026

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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