Provider Demographics
NPI:1831271055
Name:TIEN, YING-KAN (MD)
Entity type:Individual
Prefix:
First Name:YING-KAN
Middle Name:
Last Name:TIEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MATT
Other - Middle Name:
Other - Last Name:TIEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 788
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92546-0788
Mailing Address - Country:US
Mailing Address - Phone:714-636-0343
Mailing Address - Fax:714-636-0391
Practice Address - Street 1:2701 SOUTH BRISTOL ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704
Practice Address - Country:US
Practice Address - Phone:714-754-5590
Practice Address - Fax:714-850-4933
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33940207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A339400Medicaid
CA00A339400Medicaid
CA00A339400Medicaid