Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DL13763 | MA |
Y | 1223E0200X | Endodontist | 36869 | TX |
NPI | 1073094199 |
---|---|
Provider Name | Yen-Tung Chen |
First Address | El Paso, TX 79912-3621 |
Second Address | El Paso, TX 79925-8028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2018 |
Last Update Date | 16/11/2020 |