Provider Demographics
NPI:1629621073
Name:YUAN, KEVIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:YUAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 NOOKSACK AVE
Mailing Address - Street 2:
Mailing Address - City:NOOKSACK
Mailing Address - State:WA
Mailing Address - Zip Code:98276-8219
Mailing Address - Country:US
Mailing Address - Phone:360-966-3888
Mailing Address - Fax:
Practice Address - Street 1:111 NOOKSACK AVE
Practice Address - Street 2:
Practice Address - City:NOOKSACK
Practice Address - State:WA
Practice Address - Zip Code:98276-8219
Practice Address - Country:US
Practice Address - Phone:360-966-3888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA609734221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice