Provider Demographics
NPI:1366608572
Name:YEN, LO VAN (RDH)
Entity type:Individual
Prefix:
First Name:LO
Middle Name:VAN
Last Name:YEN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 CRICHTON ST
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-4931
Mailing Address - Country:US
Mailing Address - Phone:813-546-6444
Mailing Address - Fax:
Practice Address - Street 1:329 CRICHTON ST
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-4931
Practice Address - Country:US
Practice Address - Phone:813-546-6444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH19832124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist