Provider Demographics
NPI:1609929603
Name:KUAN, YIE-WEN YUAN (PHD)
Entity Type:Individual
Prefix:
First Name:YIE-WEN
Middle Name:YUAN
Last Name:KUAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4026 NE 55TH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-2262
Mailing Address - Country:US
Mailing Address - Phone:425-785-5887
Mailing Address - Fax:206-367-0627
Practice Address - Street 1:4026 NE 55TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-2262
Practice Address - Country:US
Practice Address - Phone:425-785-5887
Practice Address - Fax:206-367-0627
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2011-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 1728103TC0700X
TX24415103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAR91152Medicare UPIN
WA217000343Medicare ID - Type Unspecified