MEDICARE: KSENIA RYCKMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist

General Provider Information

NPI Number	:	1174189831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KSENIA RYCKMAN

Provider Business Mailing Address
First Line	:	19000 HOMESTEAD RD
Second Line	:
City	:	CUPERTINO
State	:	CA
Zip	:	95014-0712
Country	:	US
Telephone Number	:	408-366-4400
Fax Number	:

Provider Business Practice Location Address
First Line	:	19000 HOMESTEAD RD
Second Line	:
City	:	CUPERTINO
State	:	CA
Zip	:	95014-0712
Country	:	US
Telephone Number	:	408-366-4400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2019
Last Update Date	:	06/12/2026

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Directions to “ KSENIA RYCKMAN ” Practice Location

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