Provider Demographics
NPI:1881981488
Name:YEN, KEVIN JIA-CHIAN (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JIA-CHIAN
Last Name:YEN
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 WILLOW ST STE 5
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5101
Mailing Address - Country:US
Mailing Address - Phone:408-265-7530
Mailing Address - Fax:
Practice Address - Street 1:1660 WILLOW ST STE 5
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125
Practice Address - Country:US
Practice Address - Phone:408-265-7530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-02
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA604421223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery