Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | 104151 | CA |
NPI | 1245680271 |
---|---|
Provider Name | Dr. Ryan Cheung |
First Address | San Francisco, CA 94122-2216 |
Second Address | Playa Del Rey, CA 90293 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2016 |
Last Update Date | 22/10/2019 |