Provider Demographics
NPI:1558188995
Name:CHEN WILDMAN, YINCHEN JENNY (RDN)
Entity type:Individual
Prefix:
First Name:YINCHEN
Middle Name:JENNY
Last Name:CHEN WILDMAN
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:CHEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDN
Mailing Address - Street 1:2472 VISTA GRANDE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-7507
Mailing Address - Country:US
Mailing Address - Phone:574-323-0619
Mailing Address - Fax:
Practice Address - Street 1:2472 VISTA GRANDE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-7507
Practice Address - Country:US
Practice Address - Phone:574-323-0619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133NN1002X
CA86020612133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education