Healthcare Provider Details

I. General information

NPI: 1346566098
Provider Name (Legal Business Name): YVONNE YEN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2010
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27500 168TH PL SE
COVINGTON WA
98042-5563
US

IV. Provider business mailing address

3600 LIND AVE SW SUITE 100 ATTN CREDENTAILING
RENTON WA
98057-4970
US

V. Phone/Fax

Practice location:
  • Phone: 425-690-3430
  • Fax: 425-690-9430
Mailing address:
  • Phone: 425-690-2715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A11926
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOP60815153
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: