Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 35-06-1986 | OH |
NPI | 1215907480 |
---|---|
Provider Name | Dr. Grace Y Ryu |
First Address | Louisville, KY 40223-2992 |
Second Address | Columbus, OH 43235-5424 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 10/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
030005124 | RAILROAD MEDICARE (01) | OH |
0872435 | (05) | OH |
G30947 | (02) | OH |