Healthcare Provider Details

I. General information

NPI: 1790435055
Provider Name (Legal Business Name): ELIZABETH YEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 WESTLAKE CTR
DALY CITY CA
94015-1441
US

IV. Provider business mailing address

662 15TH AVE
SAN FRANCISCO CA
94118-3505
US

V. Phone/Fax

Practice location:
  • Phone: 650-755-8650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number108511
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: