Provider Demographics
NPI:1487643847
Name:YEN, KIMBERLY G (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:G
Last Name:YEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4771
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4771
Mailing Address - Country:US
Mailing Address - Phone:832-822-3230
Mailing Address - Fax:713-796-8110
Practice Address - Street 1:6701 FANNIN ST
Practice Address - Street 2:SUITE 510.00
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2316
Practice Address - Country:US
Practice Address - Phone:832-822-3230
Practice Address - Fax:832-825-4776
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5189207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX153943901Medicaid
TX153943903Medicaid
TX8G7721OtherBC/BS
TX4201492OtherBLUE LINK
TX153943902Medicaid
TX153943903Medicaid
H01492Medicare UPIN
TX153943902Medicaid
TX8L2193Medicare PIN
TX8A0374Medicare PIN