Provider Demographics
NPI:1134657646
Name:TIEN, AUDRIS MEIYIN (DPM)
Entity Type:Individual
Prefix:
First Name:AUDRIS
Middle Name:MEIYIN
Last Name:TIEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16405 SAND CANYON AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3792
Mailing Address - Country:US
Mailing Address - Phone:949-651-1202
Mailing Address - Fax:949-552-9493
Practice Address - Street 1:16405 SAND CANYON AVE STE 270
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3792
Practice Address - Country:US
Practice Address - Phone:949-651-1202
Practice Address - Fax:949-552-9493
Is Sole Proprietor?:No
Enumeration Date:2017-05-28
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5618213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery