Healthcare Provider Details

I. General information

NPI: 1477290062
Provider Name (Legal Business Name): RYAN CHAI LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4516 S 700 E
MURRAY UT
84107-4192
US

IV. Provider business mailing address

263 NEWPORT AVE APT 3
LONG BEACH CA
90803-5942
US

V. Phone/Fax

Practice location:
  • Phone: 323-332-9905
  • Fax:
Mailing address:
  • Phone: 888-949-4864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13414797-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: