1972593309 NPI number — DANIEL Y RYU MD

Table of content: DANIEL Y RYU MD (NPI 1972593309)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972593309 NPI number — DANIEL Y RYU MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RYU
Provider First Name:
DANIEL
Provider Middle Name:
Y
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1972593309
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6935 TREELINE DR
Provider Second Line Business Mailing Address:
STE J
Provider Business Mailing Address City Name:
BRECKSVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44141-3393
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-746-2220
Provider Business Mailing Address Fax Number:
440-746-3496

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2322 E 22ND ST
Provider Second Line Business Practice Location Address:
SVCH OCCUPATIONAL MEDICINE
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44115-3176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-363-2691
Provider Business Practice Location Address Fax Number:
216-694-4665
Provider Enumeration Date:
10/26/2005

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: 2083P0500X , with the licence number:  35-067499 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2546187 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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