MEDICARE: MS. YANNIE CHEA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	R660	MN

General Provider Information

NPI Number	:	1821449133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. YANNIE CHEA

Provider Business Mailing Address
First Line	:	616 WASHINGTON AVE SE APT 213
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55414-2998
Country	:	US
Telephone Number	:	616-458-4158
Fax Number	:

Provider Business Practice Location Address
First Line	:	616 WASHINGTON AVE SE APT 213
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55414-2998
Country	:	US
Telephone Number	:	616-458-4158
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2016
Last Update Date	:	06/28/2016

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