Provider Demographics
NPI:1215930268
Name:YEN, CHARLES L (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:L
Last Name:YEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17323 RED OAK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-1243
Mailing Address - Country:US
Mailing Address - Phone:281-440-5006
Mailing Address - Fax:281-440-6149
Practice Address - Street 1:17323 RED OAK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-1243
Practice Address - Country:US
Practice Address - Phone:281-440-5006
Practice Address - Fax:281-440-6149
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5662174400000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1215930268Medicare PIN
TX0533800001Medicare NSC
TXG11899Medicare UPIN
TX8120N0Medicare PIN
900004184Medicare PIN