Provider Demographics
NPI:1134698020
Name:WSYDDS
Entity Type:Organization
Organization Name:WSYDDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WEI SUM
Authorized Official - Middle Name:
Authorized Official - Last Name:YUEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:269-290-1418
Mailing Address - Street 1:2477 LAKE ISLE LN
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-6534
Mailing Address - Country:US
Mailing Address - Phone:269-290-1418
Mailing Address - Fax:
Practice Address - Street 1:1851 W 84TH AVE
Practice Address - Street 2:
Practice Address - City:FEDERAL HEIGHTS
Practice Address - State:CO
Practice Address - Zip Code:80260-5044
Practice Address - Country:US
Practice Address - Phone:303-429-6411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental