Healthcare Provider Details

I. General information

NPI: 1083814230
Provider Name (Legal Business Name): CHI-KWAN YEN, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 FOREST AVE
SAN JOSE CA
95128-1425
US

IV. Provider business mailing address

PO BOX 26060
FRESNO CA
93729-6060
US

V. Phone/Fax

Practice location:
  • Phone: 408-947-2502
  • Fax: 408-283-7704
Mailing address:
  • Phone: 559-455-4000
  • Fax: 559-455-4007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: CHI-KWAN YEN
Title or Position: OWNER
Credential: M.D.
Phone: 408-947-2502