Provider Demographics
NPI:1346723970
Name:YENCHI, ERIC KOWSHOH
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:KOWSHOH
Last Name:YENCHI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8102 KITTAMA DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3155
Mailing Address - Country:US
Mailing Address - Phone:406-431-0632
Mailing Address - Fax:
Practice Address - Street 1:8102 KITTAMA DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3155
Practice Address - Country:US
Practice Address - Phone:240-643-1063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1022843163WP0807X, 363LP0808X
MDR194744363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent