Provider Demographics
NPI:1659264406
Name:KHYENTSE, TENZIN
Entity type:Individual
Prefix:
First Name:TENZIN
Middle Name:
Last Name:KHYENTSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-2039
Mailing Address - Country:US
Mailing Address - Phone:781-321-1017
Mailing Address - Fax:
Practice Address - Street 1:575 BROADWAY
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-2039
Practice Address - Country:US
Practice Address - Phone:781-321-1017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-30
Last Update Date:2025-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH1001184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist