Healthcare Provider Details

I. General information

NPI: 1992847925
Provider Name (Legal Business Name): JENNY YEN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10123 N WOLFE RD STE 2009
CUPERTINO CA
95014-2535
US

IV. Provider business mailing address

4207 HAMILTON AVE
SAN JOSE CA
95130-1462
US

V. Phone/Fax

Practice location:
  • Phone: 408-255-8100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11986T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: