Provider Demographics
NPI:1396836540
Name:RYOO, JEI WOO (MD)
Entity Type:Individual
Prefix:
First Name:JEI
Middle Name:WOO
Last Name:RYOO
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 1:1816 DUNHILL CIR
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-7618
Mailing Address - Country:US
Mailing Address - Phone:847-486-9488
Mailing Address - Fax:
Practice Address - Street 1:820 S. DAMEN AVE
Practice Address - Street 2:PATH & LAB MEDICINE SERVICE (MP 113)
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-569-6696
Practice Address - Fax:312-569-6122
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36-057271OtherSTATE ILLINOIS LICENSE NU