Provider Demographics
NPI:1083471106
Name:YEN, SAMUEL
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:YEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SAMUEL
Other - Middle Name:ZON-EN
Other - Last Name:YEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10 HATHORN ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-3323
Mailing Address - Country:US
Mailing Address - Phone:408-499-1521
Mailing Address - Fax:
Practice Address - Street 1:10 HATHORN ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-3323
Practice Address - Country:US
Practice Address - Phone:408-499-1521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2361088163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse