Provider Demographics
NPI:1003477399
Name:RYU, ANDREW HOSEUNG (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:HOSEUNG
Last Name:RYU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 NW 107TH AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178
Mailing Address - Country:US
Mailing Address - Phone:305-418-7771
Mailing Address - Fax:
Practice Address - Street 1:3601 NW 107TH AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178
Practice Address - Country:US
Practice Address - Phone:305-418-7771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX353491223G0001X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223G0001XDental ProvidersDentistGeneral Practice