Healthcare Provider Details

I. General information

NPI: 1013919786
Provider Name (Legal Business Name): ALEXANDER YUEN B.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 S LOS ROBLES AVE
PASADENA CA
91101-2417
US

IV. Provider business mailing address

117 S LOS ROBLES AVE
PASADENA CA
91101-2417
US

V. Phone/Fax

Practice location:
  • Phone: 626-795-8628
  • Fax: 626-585-1742
Mailing address:
  • Phone: 626-585-9544
  • Fax: 626-449-4932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number35571
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: