Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 036.148255 | IL |
Y | 207T00000X | Neurosurgeon | MD200041 | OR |
NPI | 1043872492 |
---|---|
Provider Name | Won Hyung Ryu |
First Address | Portland, OR 97239-4501 |
Second Address | Portland, OR 97239-4501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2019 |
Last Update Date | 30/09/2020 |