Healthcare Provider Details

I. General information

NPI: 1366493033
Provider Name (Legal Business Name): RAYMOND SHUEN-YI YEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 E CALIFORNIA BLVD THIRD FLOOR
PASADENA CA
91105-3954
US

IV. Provider business mailing address

55 E CALIFORNIA BLVD THIRD FLOOR
PASADENA CA
91105-3954
US

V. Phone/Fax

Practice location:
  • Phone: 626-793-1227
  • Fax: 626-793-3794
Mailing address:
  • Phone: 626-793-1227
  • Fax: 626-793-3794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG61728
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: