Healthcare Provider Details

I. General information

NPI: 1922485978
Provider Name (Legal Business Name): JARED YEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 BENTON ST DEPT OF NEUROLOGY
LOMA LINDA CA
92357-1000
US

IV. Provider business mailing address

11201 BENTON ST DEPT OF NEUROLOGY
LOMA LINDA CA
92357-1000
US

V. Phone/Fax

Practice location:
  • Phone: 909-825-7084
  • Fax: 909-777-3814
Mailing address:
  • Phone: 909-825-7084
  • Fax: 909-777-3814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number62663
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberA144783
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: