Healthcare Provider Details

I. General information

NPI: 1710043328
Provider Name (Legal Business Name): MATTHEW BLAZON YEE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 BROOKSHIRE AVE # GME
DOWNEY CA
90241-4917
US

IV. Provider business mailing address

1225 WILSHIRE BLVD
LOS ANGELES CA
90017-1901
US

V. Phone/Fax

Practice location:
  • Phone: 562-904-5401
  • Fax: 562-904-5214
Mailing address:
  • Phone: 213-977-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20163
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: