Provider Demographics
NPI:1255380986
Name:WEN, CHUN YUEH (MD)
Entity type:Individual
Prefix:DR
First Name:CHUN YUEH
Middle Name:
Last Name:WEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:THOMAS
Other - Middle Name:C
Other - Last Name:WEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2303 17TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3503
Mailing Address - Country:US
Mailing Address - Phone:661-322-1931
Mailing Address - Fax:661-322-4349
Practice Address - Street 1:2303 17TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3503
Practice Address - Country:US
Practice Address - Phone:661-322-1931
Practice Address - Fax:661-322-4349
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38188207RI0011X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A381880Medicare ID - Type Unspecified