Healthcare Provider Details

I. General information

NPI: 1225907199
Provider Name (Legal Business Name): NICOLE YEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2025
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11900 SOUTH ST STE 118
CERRITOS CA
90703-6800
US

IV. Provider business mailing address

3861 MEADOW PARK LN
TORRANCE CA
90505-3742
US

V. Phone/Fax

Practice location:
  • Phone: 562-800-3072
  • Fax:
Mailing address:
  • Phone: 310-961-7987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: