1578096269 NPI number — DR. YUN KYOUNG RYU TIGER M.D

Table of content: DR. YUN KYOUNG RYU TIGER M.D (NPI 1578096269)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578096269 NPI number — DR. YUN KYOUNG RYU TIGER M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TIGER
Provider First Name:
YUN KYOUNG
Provider Middle Name:
RYU
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TIGER
Provider Other First Name:
CLAIRE
Provider Other Middle Name:
RYU
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD, PHD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1578096269
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
77 FORT WASHINGTON AVE
Provider Second Line Business Mailing Address:
INTERNAL MEDICINE RESIDENCY OFFICE, FLOOR 6, CENTER 12
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10032-3733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-305-6262
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
195 LITTLE ALBANY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BRUNSWICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08901-1914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-235-2465
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/10/2017

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: 207RH0003X , with the licence number:  306307 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: 25MA11969100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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