Provider Demographics
NPI:1720153497
Name:RYU, BYUONG C (MD)
Entity Type:Individual
Prefix:DR
First Name:BYUONG
Middle Name:C
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 1:475 IRVING AVE
Mailing Address - Street 2:#108
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1756
Mailing Address - Country:US
Mailing Address - Phone:315-671-0070
Mailing Address - Fax:
Practice Address - Street 1:475 IRVING AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1756
Practice Address - Country:US
Practice Address - Phone:315-671-0070
Practice Address - Fax:315-475-0620
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209295174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
BB3720Medicare PIN
NYG86949Medicare UPIN