Provider Demographics
NPI:1114344900
Name:RYU, JIWOON (DC)
Entity Type:Individual
Prefix:DR
First Name:JIWOON
Middle Name:
Last Name:RYU
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25925 LARGO CT.
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:MD
Mailing Address - Zip Code:20872
Mailing Address - Country:US
Mailing Address - Phone:607-423-0452
Mailing Address - Fax:
Practice Address - Street 1:18 PARK AVE
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-5438
Practice Address - Country:US
Practice Address - Phone:301-703-8230
Practice Address - Fax:301-703-8219
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-18
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS03776111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD8825 - 0035OtherCAREFIRST
VAK949 - 0075OtherCAREFIRST