Provider Demographics
NPI:1881858991
Name:YEN, CORNELIUS LISEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CORNELIUS
Middle Name:LISEN
Last Name:YEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13630 MAPLE AVE
Mailing Address - Street 2:STE 2E
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3867
Mailing Address - Country:US
Mailing Address - Phone:718-358-1200
Mailing Address - Fax:
Practice Address - Street 1:13630 MAPLE AVE STE 2E
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3867
Practice Address - Country:US
Practice Address - Phone:718-358-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0538961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03026395Medicaid