Healthcare Provider Details

I. General information

NPI: 1891082368
Provider Name (Legal Business Name): YEN CHEN KEVIN KO M.D., D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 W 10TH AVE JPPN, 1ST FL, RM 1250
VANCOUVER BC
V5Z 1M9
CA

IV. Provider business mailing address

300 PASTEUR DR LANE 235
STANFORD CA
94305-2200
US

V. Phone/Fax

Practice location:
  • Phone: 604-875-4577
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number058945
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberA151446
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: