Provider Demographics
NPI:1407180656
Name:MCKIM, RYAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:MCKIM
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 DIVISADERO ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-2213
Mailing Address - Country:US
Mailing Address - Phone:415-531-9202
Mailing Address - Fax:
Practice Address - Street 1:530 DIVISADERO ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-2213
Practice Address - Country:US
Practice Address - Phone:415-531-9202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22874103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist