Provider Demographics
NPI:1053635193
Name:YUEN, WAHYAN CONNIE
Entity Type:Individual
Prefix:
First Name:WAHYAN
Middle Name:CONNIE
Last Name:YUEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 117TH ST
Mailing Address - Street 2:
Mailing Address - City:COLLEGE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11356-1024
Mailing Address - Country:US
Mailing Address - Phone:917-929-0570
Mailing Address - Fax:
Practice Address - Street 1:14-18 ELIZABETH ST
Practice Address - Street 2:UNIT 15
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013
Practice Address - Country:US
Practice Address - Phone:212-732-3388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050839183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist