Provider Demographics
NPI:1750488649
Name:YEN, AN (MD)
Entity Type:Individual
Prefix:
First Name:AN
Middle Name:
Last Name:YEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1495 RIVER PARK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4500
Mailing Address - Country:US
Mailing Address - Phone:916-925-7020
Mailing Address - Fax:916-925-3680
Practice Address - Street 1:1495 RIVER PARK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4500
Practice Address - Country:US
Practice Address - Phone:916-925-7020
Practice Address - Fax:916-925-3680
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA056462207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G92996Medicare UPIN
00A564620Medicare ID - Type Unspecified