Provider Demographics
NPI:1376136689
Name:DAHL, YEN NGOC (WHNP-BC, CNM)
Entity Type:Individual
Prefix:
First Name:YEN
Middle Name:NGOC
Last Name:DAHL
Suffix:
Gender:F
Credentials:WHNP-BC, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1353 OLD TEMESCAL RD
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-7262
Mailing Address - Country:US
Mailing Address - Phone:951-547-4208
Mailing Address - Fax:
Practice Address - Street 1:1353 OLD TEMESCAL RD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-7262
Practice Address - Country:US
Practice Address - Phone:951-547-4208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA236173176B00000X
CA95016662363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health