Provider Demographics
NPI:1821053588
Name:YEN FAMILY DENTAL LLC
Entity Type:Organization
Organization Name:YEN FAMILY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:CALVIN
Authorized Official - Last Name:YEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-243-5740
Mailing Address - Street 1:16006 MILITARY RD S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98188
Mailing Address - Country:US
Mailing Address - Phone:206-243-5740
Mailing Address - Fax:206-243-5952
Practice Address - Street 1:16006 MILITARY RD S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98188
Practice Address - Country:US
Practice Address - Phone:206-243-5740
Practice Address - Fax:206-243-5952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00007095122300000X
WA60164117611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty