Healthcare Provider Details

I. General information

NPI: 1285070938
Provider Name (Legal Business Name): PHILIP M. YEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 11/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 E PRENTICE AVE STE 215
GREENWOOD VILLAGE CO
80111-2990
US

IV. Provider business mailing address

8301 E PRENTICE AVE STE 215
GREENWOOD VILLAGE CO
80111-2990
US

V. Phone/Fax

Practice location:
  • Phone: 720-606-4220
  • Fax: 720-606-4221
Mailing address:
  • Phone: 720-606-4220
  • Fax: 720-606-4221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number60416
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License NumberDEN.00201863
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number00201863
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: