Provider Demographics
NPI:1811244825
Name:YEN, TIMOTHY KC (PSYD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:KC
Last Name:YEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 CAMELBACK RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-1333
Mailing Address - Country:US
Mailing Address - Phone:925-385-8228
Mailing Address - Fax:
Practice Address - Street 1:6444 SIERRA CT
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2614
Practice Address - Country:US
Practice Address - Phone:925-390-3246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27745103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical