Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 032210 | CA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 32210 | CA |
NPI | 1447356597 |
---|---|
Provider Name | Chung Kwan Yen |
First Address | Palo Alto, CA 94304-1601 |
Second Address | Palo Alto, CA 94304-1601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 14/04/2021 |