Provider Demographics
NPI:1811384878
Name:PHAN, YEN (DO)
Entity Type:Individual
Prefix:
First Name:YEN
Middle Name:
Last Name:PHAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 E PIONEER PKWY
Mailing Address - Street 2:STE 135
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-5875
Mailing Address - Country:US
Mailing Address - Phone:817-460-2580
Mailing Address - Fax:
Practice Address - Street 1:1115 E PIONEER PKWY
Practice Address - Street 2:STE 135
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-5875
Practice Address - Country:US
Practice Address - Phone:817-460-2580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-16
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR7852207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine