Provider Demographics
NPI:1720602964
Name:MAN, CI YEN JOANNA (DDS)
Entity Type:Individual
Prefix:MS
First Name:CI YEN
Middle Name:JOANNA
Last Name:MAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 PARK AVE.
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102
Mailing Address - Country:US
Mailing Address - Phone:207-874-1028
Mailing Address - Fax:207-842-2963
Practice Address - Street 1:190 PARK AVE.
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-874-1028
Practice Address - Fax:207-842-2963
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program