Provider Demographics
NPI:1063428779
Name:YEN, RODNEY GEORGE (DPM)
Entity type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:GEORGE
Last Name:YEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 MADISON ST
Mailing Address - Street 2:SUITE 901
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1172
Mailing Address - Country:US
Mailing Address - Phone:206-264-8100
Mailing Address - Fax:
Practice Address - Street 1:515 MINOR AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2120
Practice Address - Country:US
Practice Address - Phone:206-386-9668
Practice Address - Fax:206-386-9544
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO460213E00000X
WAPO00000460213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1076918Medicaid
WAU23785Medicare UPIN
WA0614180001Medicare NSC
WAGD00102274Medicare ID - Type Unspecified