Healthcare Provider Details

I. General information

NPI: 1396802005
Provider Name (Legal Business Name): DAVID JENG-PING YEN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 6TH AVE FL 5
SAN FRANCISCO CA
94118-3010
US

IV. Provider business mailing address

1777 SHORELINE DR APT 329
ALAMEDA CA
94501-6078
US

V. Phone/Fax

Practice location:
  • Phone: 415-833-2318
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number18387
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: