Healthcare Provider Details

I. General information

NPI: 1174565576
Provider Name (Legal Business Name): CHIH J YEN DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 MEDICAL PLAZA LN
WHITESBURG KY
41858
US

IV. Provider business mailing address

PO BOX 40
WHITESBURG KY
41858-0040
US

V. Phone/Fax

Practice location:
  • Phone: 606-633-4871
  • Fax: 606-633-0883
Mailing address:
  • Phone: 606-633-4823
  • Fax: 606-633-1874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number244057
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number244057
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: