Provider Demographics
NPI:1598406183
Name:YAM, RYAN W
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:W
Last Name:YAM
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 1:6483 LAGUNA MIRAGE LN
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-5464
Mailing Address - Country:US
Mailing Address - Phone:415-350-1092
Mailing Address - Fax:
Practice Address - Street 1:885 N SAN ANTONIO RD STE O
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1341
Practice Address - Country:US
Practice Address - Phone:415-350-1092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94026536103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist