Healthcare Provider Details

I. General information

NPI: 1700796232
Provider Name (Legal Business Name): RYAN KOCHAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7504 E INDEPENDENCE BLVD STE 103
CHARLOTTE NC
28227-9407
US

IV. Provider business mailing address

7504 E INDEPENDENCE BLVD STE 103
CHARLOTTE NC
28227-9407
US

V. Phone/Fax

Practice location:
  • Phone: 910-400-9013
  • Fax:
Mailing address:
  • Phone: 910-400-9013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number25481826
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: