Provider Demographics
NPI:1609051317
Name:CHAN, YEOU REN (DDS)
Entity Type:Individual
Prefix:
First Name:YEOU REN
Middle Name:
Last Name:CHAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:YEOU REN
Other - Middle Name:
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:5480 PHILADELPHIA STREET, #D
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710
Mailing Address - Country:US
Mailing Address - Phone:909-464-2399
Mailing Address - Fax:909-464-2398
Practice Address - Street 1:5480 PHILADELPHIA STREET, #D
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710
Practice Address - Country:US
Practice Address - Phone:909-464-2399
Practice Address - Fax:909-464-2398
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB-358561223G0001X
CA35856122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice