MEDICARE: NORMA YUEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1215647342
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORMA YUEN

Provider Business Mailing Address
First Line	:	2013 DAIRY MART RD UNIT 3
Second Line	:
City	:	SAN YSIDRO
State	:	CA
Zip	:	92173-1848
Country	:	US
Telephone Number	:	619-209-8924
Fax Number	:

Provider Business Practice Location Address
First Line	:	AV DEFENSORES 702
Second Line	:
City	:	TIJUANA
State	:	CALIFORNIA
Zip	:	22350
Country	:	MX
Telephone Number	:	619-209-8924
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF DENTAL BILLING
Name	:	HECTOR MORALES FERNANDEZ
Credential	:
Telephone Number	:	619-209-8924

Provider Enumeration Date	:	11/30/2022
Last Update Date	:	11/30/2022

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Directions to “NORMA YUEN ” Practice Location

Language	Start Address	Practice Location

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