Healthcare Provider Details

I. General information

NPI: 1720953672
Provider Name (Legal Business Name): RYAN NG RD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2025
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

978A JACKSON ST
SAN FRANCISCO CA
94133-7195
US

IV. Provider business mailing address

978A JACKSON ST
SAN FRANCISCO CA
94133-7195
US

V. Phone/Fax

Practice location:
  • Phone: 415-730-4840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86106190
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: