Provider Demographics
NPI:1477082931
Name:YOON, RYAN JOSEPH (DO)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:JOSEPH
Last Name:YOON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 68TH STREET SE
Mailing Address - Street 2:PINE REST CHRISTIAN MENTAL HEALTH SERVICES
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548
Mailing Address - Country:US
Mailing Address - Phone:616-456-0842
Mailing Address - Fax:616-559-5864
Practice Address - Street 1:17325 VAN WAGONER RD
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:MI
Practice Address - Zip Code:49456-9702
Practice Address - Country:US
Practice Address - Phone:616-847-5145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010231662084P0800X
MI51510125552084P0800X
MI51010261462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry