Provider Demographics
NPI:1083471106
Name:YEN, SAMUEL
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:YEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:SAMUEL
Other - Middle Name:ZON-EN
Other - Last Name:YEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:29 BOG RD APT 20
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03303-2018
Mailing Address - Country:US
Mailing Address - Phone:408-499-1521
Mailing Address - Fax:
Practice Address - Street 1:99 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3852
Practice Address - Country:US
Practice Address - Phone:603-229-3912
Practice Address - Fax:603-224-9881
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2361088163W00000X
NH113364-23363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse