Healthcare Provider Details

I. General information

NPI: 1386772614
Provider Name (Legal Business Name): SAMUEL HANDACK YEE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MAREBLU STE 300
ALISO VIEJO CA
92656-3047
US

IV. Provider business mailing address

15 MAREBLU 300
ALISO VIEJO CA
92656
US

V. Phone/Fax

Practice location:
  • Phone: 949-831-3111
  • Fax: 949-360-0368
Mailing address:
  • Phone: 949-831-3111
  • Fax: 949-360-0368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number26944
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: