Provider Demographics
NPI:1194942789
Name:CHEN, YVONNE Y
Entity type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:Y
Last Name:CHEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2092 CONCOURSE DR
Mailing Address - Street 2:SUITE #21
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-1893
Mailing Address - Country:US
Mailing Address - Phone:408-504-3112
Mailing Address - Fax:
Practice Address - Street 1:2092 CONCOURSE DR
Practice Address - Street 2:SUITE #21
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-1893
Practice Address - Country:US
Practice Address - Phone:408-504-3112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31226122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist