Provider Demographics
NPI:1457478661
Name:PHEN, YUCHI (DMD)
Entity Type:Individual
Prefix:DR
First Name:YUCHI
Middle Name:
Last Name:PHEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 N FLAMINGO RD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-3502
Mailing Address - Country:US
Mailing Address - Phone:954-885-8762
Mailing Address - Fax:954-885-8760
Practice Address - Street 1:2212 N FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-3502
Practice Address - Country:US
Practice Address - Phone:954-885-8762
Practice Address - Fax:954-885-8760
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN149811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice