Healthcare Provider Details

I. General information

NPI: 1245680271
Provider Name (Legal Business Name): RYAN CHEUNG D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8055 WEST MANCHESTER AVENUE SUITE 204
PLAYA DEL REY CA
90293
US

IV. Provider business mailing address

1032 IRVING ST # 928
SAN FRANCISCO CA
94122-2216
US

V. Phone/Fax

Practice location:
  • Phone: 415-812-0503
  • Fax:
Mailing address:
  • Phone: 415-812-0503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number104151
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: