Provider Demographics
NPI:1427039932
Name:RYU, JEFFREY Y (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:Y
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 1:2545 S BRUCE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-1778
Mailing Address - Country:US
Mailing Address - Phone:702-732-2438
Mailing Address - Fax:702-737-5043
Practice Address - Street 1:2450 FIRE MESA ST STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-9034
Practice Address - Country:US
Practice Address - Phone:702-853-0090
Practice Address - Fax:702-853-0096
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11350207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ234076Medicaid
NV100505715Medicaid
NV1427039932Medicaid
AZ234076Medicaid
NV100505715Medicaid