Provider Demographics
NPI:1639637895
Name:YEN, CHENG YI TENG
Entity Type:Individual
Prefix:
First Name:CHENG YI
Middle Name:TENG
Last Name:YEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHENG YI
Other - Middle Name:
Other - Last Name:TENG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3723 CROOKED CREEK DR
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3761
Mailing Address - Country:US
Mailing Address - Phone:347-604-0316
Mailing Address - Fax:
Practice Address - Street 1:330 E LAMBERT RD STE 225
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-4128
Practice Address - Country:US
Practice Address - Phone:626-789-5796
Practice Address - Fax:714-257-7987
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT109800106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist