Provider Demographics
NPI:1023366721
Name:RYAN, MATTHEW HEPNER (PHD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:HEPNER
Last Name:RYAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1990 S BUNDY DR STE 320
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5249
Mailing Address - Country:US
Mailing Address - Phone:310-826-3235
Mailing Address - Fax:310-447-0840
Practice Address - Street 1:1990 S BUNDY DR STE 320
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5249
Practice Address - Country:US
Practice Address - Phone:310-826-3235
Practice Address - Fax:310-447-0840
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11540103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical