Individual provider Active NPI

Jei Woo Ryoo, M.D.

  • Specialist
  • Chicago, IL
National Provider Identifier
1396836540
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Practice address
820 S. Damen Ave
Path & Lab Medicine Service (MP 113)
Chicago, IL 60612
Phone
(312) 569-6696
Fax
(312) 569-6122
NPI assigned
Sep 27, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X IL Primary

Addresses

Primary practice location

820 S. Damen Ave
Path & Lab Medicine Service (MP 113)
Chicago, IL 60612

Mailing address

1816 Dunhill Cir
Glenview, IL 60025-7618
Phone (847) 486-9488

Other identifiers 1

IdentifierTypeStateIssuer
36-057271OtherILSTATE ILLINOIS LICENSE NU

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036-057271ILMDSpecialist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1396836540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1816 DUNHILL CIR",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600257618",
            "telephone_number": "847-486-9488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 S. DAMEN AVE",
            "address_2": "PATH & LAB MEDICINE SERVICE (MP 113)",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60612",
            "telephone_number": "312-569-6696",
            "fax_number": "312-569-6122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYOO",
        "first_name": "JEI",
        "middle_name": "WOO",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE ILLINOIS LICENSE NU",
            "identifier": "36-057271",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.