Provider Demographics
NPI:1215133061
Name:YUEN, BERTINA CARMEN (DMD, MMSC)
Entity type:Individual
Prefix:DR
First Name:BERTINA
Middle Name:CARMEN
Last Name:YUEN
Suffix:
Gender:F
Credentials:DMD, MMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1927 TERRA LN
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-8140
Mailing Address - Country:US
Mailing Address - Phone:617-966-3713
Mailing Address - Fax:
Practice Address - Street 1:247 N LAKE AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1828
Practice Address - Country:US
Practice Address - Phone:626-405-2922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN-21454-11223P0300X
CA531161223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics