Provider Demographics
NPI:1932761004
Name:HERSHEY-VAN HORN, RYAN CHRISTOPHER
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:CHRISTOPHER
Last Name:HERSHEY-VAN HORN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:HERSHEY-VAN HORN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:500 DAVIS ST STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-2759
Mailing Address - Country:US
Mailing Address - Phone:510-481-4203
Mailing Address - Fax:510-481-4269
Practice Address - Street 1:500 DAVIS ST STE 120
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-2759
Practice Address - Country:US
Practice Address - Phone:510-481-4203
Practice Address - Fax:510-481-4269
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program