Provider Demographics
NPI:1114228715
Name:SUNG HA RYOO M D INC
Entity Type:Organization
Organization Name:SUNG HA RYOO M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNG
Authorized Official - Middle Name:HA
Authorized Official - Last Name:RYOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-432-8422
Mailing Address - Street 1:2250 GLADSTONE DR STE 1
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-5124
Mailing Address - Country:US
Mailing Address - Phone:925-432-8422
Mailing Address - Fax:925-432-8264
Practice Address - Street 1:2250 GLADSTONE DR STE 1
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-5124
Practice Address - Country:US
Practice Address - Phone:925-432-8422
Practice Address - Fax:925-432-8264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32405207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A324050Medicaid
CA00A324050Medicaid