Provider Demographics
NPI:1255409363
Name:MA, YEN M (OD)
Entity type:Individual
Prefix:DR
First Name:YEN
Middle Name:M
Last Name:MA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:PO BOX 70453
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92513-0453
Mailing Address - Country:US
Mailing Address - Phone:951-776-7820
Mailing Address - Fax:951-776-7820
Practice Address - Street 1:900 E MORTON PL
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4529
Practice Address - Country:US
Practice Address - Phone:951-658-9409
Practice Address - Fax:951-658-2057
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT11180T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11939OtherMEDICAL EYE SERVICES
CAU94069Medicare UPIN