Healthcare Provider Details

I. General information

NPI: 1124111232
Provider Name (Legal Business Name): OWEN YEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 06/28/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 ROUTE 25A SUITE C
SHOREHAM NY
11786-1389
US

IV. Provider business mailing address

45 ROUTE 25A SUITE C
SHOREHAM NY
11786-1389
US

V. Phone/Fax

Practice location:
  • Phone: 631-744-3303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number146883
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: