Provider Demographics
NPI:1437779402
Name:CHAN, RYAN NICHOLAS
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:NICHOLAS
Last Name:CHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7429 MYRTLE VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-4047
Mailing Address - Country:US
Mailing Address - Phone:916-712-4462
Mailing Address - Fax:
Practice Address - Street 1:3475 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2550
Practice Address - Country:US
Practice Address - Phone:916-712-4462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-20
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program