Provider Demographics
NPI:1245330091
Name:YEN, NELSON T (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:NELSON
Middle Name:T
Last Name:YEN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 LAGUNA RD STE B
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3650
Mailing Address - Country:US
Mailing Address - Phone:714-441-0436
Mailing Address - Fax:
Practice Address - Street 1:130 LAGUNA RD STE B
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3650
Practice Address - Country:US
Practice Address - Phone:714-441-0436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA462311223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics