Provider Demographics
NPI:1134879786
Name:RYU, SALLY HEIRI
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:HEIRI
Last Name:RYU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEI RI
Other - Middle Name:
Other - Last Name:RYU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1635 PIERCE ST APT 12
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3148
Mailing Address - Country:US
Mailing Address - Phone:949-545-3348
Mailing Address - Fax:
Practice Address - Street 1:1635 PIERCE ST APT 12
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3148
Practice Address - Country:US
Practice Address - Phone:949-545-3348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-26
Last Update Date:2022-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist