Provider Demographics
NPI:1225012735
Name:YEN, TONY (MD)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:
Last Name:YEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ANTONIO
Other - Middle Name:
Other - Last Name:YEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 34036
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1036
Mailing Address - Country:US
Mailing Address - Phone:425-899-3292
Mailing Address - Fax:425-899-3269
Practice Address - Street 1:12040 NE 128TH ST
Practice Address - Street 2:MS #105
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3013
Practice Address - Country:US
Practice Address - Phone:425-899-2560
Practice Address - Fax:425-899-2079
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033921207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8205536Medicaid
WA110199988OtherMEDICARE RAILROAD
WAYE6650OtherBLUE SHIELD
WA137158OtherLABOR & INDUSTRIES
WA137158OtherLABOR & INDUSTRIES
WAG43250Medicare UPIN