Healthcare Provider Details

I. General information

NPI: 1215133061
Provider Name (Legal Business Name): BERTINA CARMEN YUEN D.M.D., MMSC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 02/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 N LAKE AVE
PASADENA CA
91101-1828
US

IV. Provider business mailing address

1927 TERRA LN
ARCADIA CA
91007-8140
US

V. Phone/Fax

Practice location:
  • Phone: 626-405-2922
  • Fax:
Mailing address:
  • Phone: 617-966-3713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN-21454-1
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number53116
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: