Healthcare Provider Details

I. General information

NPI: 1609929603
Provider Name (Legal Business Name): YIE-WEN YUAN KUAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2007
Last Update Date: 01/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4026 NE 55TH ST SUITE D
SEATTLE WA
98105-2262
US

IV. Provider business mailing address

4026 NE 55TH ST SUITE D
SEATTLE WA
98105-2262
US

V. Phone/Fax

Practice location:
  • Phone: 425-785-5887
  • Fax: 206-367-0627
Mailing address:
  • Phone: 425-785-5887
  • Fax: 206-367-0627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY 1728
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number24415
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: