Provider Demographics
NPI:1902117575
Name:YEN-DOUANGMALA, DAPHNE SHIENMEI (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAPHNE
Middle Name:SHIENMEI
Last Name:YEN-DOUANGMALA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 ANTOINETTE CT
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-5131
Mailing Address - Country:US
Mailing Address - Phone:847-687-1411
Mailing Address - Fax:
Practice Address - Street 1:975 SERENO DR
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2441
Practice Address - Country:US
Practice Address - Phone:847-687-1411
Practice Address - Fax:707-651-3685
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAEL1833213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery