Provider Demographics
NPI:1063897916
Name:CULLEN, YAN RONG (DPM)
Entity type:Individual
Prefix:
First Name:YAN RONG
Middle Name:
Last Name:CULLEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:YAN RONG
Other - Middle Name:
Other - Last Name:CHOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:13030 121ST WAY NE STE 204
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3008
Mailing Address - Country:US
Mailing Address - Phone:425-822-7426
Mailing Address - Fax:
Practice Address - Street 1:13030 121ST WAY NE STE 204
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3008
Practice Address - Country:US
Practice Address - Phone:425-822-7426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006826213ES0103X
WAPO60894973213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery