Provider Demographics
NPI:1730163189
Name:RYU, JEONG HO (MD)
Entity type:Individual
Prefix:
First Name:JEONG
Middle Name:HO
Last Name:RYU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6785 COUNTY LINE LN
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5726
Mailing Address - Country:US
Mailing Address - Phone:773-817-8688
Mailing Address - Fax:773-866-1930
Practice Address - Street 1:3258 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-5223
Practice Address - Country:US
Practice Address - Phone:773-817-8688
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31600945OtherBCBS
IL31600945OtherBCBS
C41384Medicare UPIN