Healthcare Provider Details

I. General information

NPI: 1447512041
Provider Name (Legal Business Name): AMY YUAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 NW 5TH ST
REDMOND OR
97756-1869
US

IV. Provider business mailing address

1120 MINNEQUA AVE
PUEBLO CO
81004-3734
US

V. Phone/Fax

Practice location:
  • Phone: 541-526-6635
  • Fax: 541-526-6636
Mailing address:
  • Phone: 719-564-0660
  • Fax: 719-564-0037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDR.0057203
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: