Healthcare Provider Details

I. General information

NPI: 1659375988
Provider Name (Legal Business Name): JESSICA YIH-WEN NIEN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

991 MONTAGUE EXPY SUITE #108
MILPITAS CA
95035-6818
US

IV. Provider business mailing address

991 MONTAGUE EXPY SUITE #108
MILPITAS CA
95035-6818
US

V. Phone/Fax

Practice location:
  • Phone: 408-262-8747
  • Fax: 408-262-8009
Mailing address:
  • Phone: 408-262-8747
  • Fax: 408-262-8009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number44234
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: