Provider Demographics
NPI:1629123500
Name:CHENG, RYAN (OTR)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:CHENG
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 ARNOLD WAY
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-5748
Mailing Address - Country:US
Mailing Address - Phone:714-447-1777
Mailing Address - Fax:714-758-9555
Practice Address - Street 1:13341 GARDEN GROVE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-2255
Practice Address - Country:US
Practice Address - Phone:714-750-4097
Practice Address - Fax:714-750-4616
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT3419225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist