Provider Demographics
NPI:1518159003
Name:SENG, DC-RYAN B (PA)
Entity Type:Individual
Prefix:
First Name:DC-RYAN
Middle Name:B
Last Name:SENG
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 93723
Mailing Address - Street 2:
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91715-3723
Mailing Address - Country:US
Mailing Address - Phone:323-277-9010
Mailing Address - Fax:
Practice Address - Street 1:2643 SANTA ANA ST
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-2025
Practice Address - Country:US
Practice Address - Phone:323-277-9010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15984363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA74-3050085OtherGROUP TAX ID#
CAPA15984OtherLICENSE
CAGR0092891Medicaid