Healthcare Provider Details

I. General information

NPI: 1699271379
Provider Name (Legal Business Name): JASMINE YEE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9327 LAGUNA SPRINGS DR STE 110
ELK GROVE CA
95758-7832
US

IV. Provider business mailing address

9327 LAGUNA SPRINGS DR STE 110
ELK GROVE CA
95758-7832
US

V. Phone/Fax

Practice location:
  • Phone: 916-684-8373
  • Fax:
Mailing address:
  • Phone: 916-684-8373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number102673
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: