Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 35349 | TX |
Y | 213EG0000X | General Practice | 35349 | TX |
NPI | 1003477399 |
---|---|
Provider Name | Dr. Andrew Hoseung Ryu |
First Address | Palmhurst, TX 78573 |
Second Address | Palmhurst, TX 78573 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2019 |
Last Update Date | 26/06/2019 |