MEDICARE: YEN FAMILY DENTAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DE00007095	WA
2	1223G0001X	General Practice Dentistry	6016411761	WA

General Provider Information

NPI Number	:	1821053588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YEN FAMILY DENTAL LLC

Provider Business Mailing Address
First Line	:	16006 MILITARY RD S
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98188
Country	:	US
Telephone Number	:	206-243-5740
Fax Number	:	206-243-5952

Provider Business Practice Location Address
First Line	:	16006 MILITARY RD S
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98188
Country	:	US
Telephone Number	:	206-243-5740
Fax Number	:	206-243-5952

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. GREGORY CALVIN YEN
Credential	:	DDS
Telephone Number	:	206-243-5740

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	08/27/2008

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