Provider Demographics
NPI:1881986255
Name:RYU, JIYOUNG (MD)
Entity type:Individual
Prefix:
First Name:JIYOUNG
Middle Name:
Last Name:RYU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 PERIMETER CTR N
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30346-3402
Mailing Address - Country:US
Mailing Address - Phone:877-513-7274
Mailing Address - Fax:888-508-2509
Practice Address - Street 1:8601 SIX FORKS RD
Practice Address - Street 2:SUITE 400
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5276
Practice Address - Country:US
Practice Address - Phone:919-578-9118
Practice Address - Fax:919-578-9118
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA67981208100000X
NC2013-02202208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003127587AMedicaid
GAPE253848Medicare PIN
NCD340Medicare PIN