=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538254396
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NELSON T. YEN DDS, MS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 01/19/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 220 LAGUNA RD SUITE 3
-----------------------------------------------------
City | FULLERTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92835-2523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-441-0436
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 130 LAGUNA RD STE B
-----------------------------------------------------
City | FULLERTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92835-3650
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-441-0436
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EMPLOYER
-----------------------------------------------------
Name | DR. NELSON T YEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 714-381-4699
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0300X
-----------------------------------------------------
Taxonomy Name | Periodontics
-----------------------------------------------------
License Number | 29240
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223P0300X
-----------------------------------------------------
Taxonomy Name | Periodontics
-----------------------------------------------------
License Number | 46231
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------