Healthcare Provider Details

I. General information

NPI: 1568540524
Provider Name (Legal Business Name): WAYNE TAM YEE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 COFFEE ROAD SUITE 1
MODESTO CA
95355-1768
US

IV. Provider business mailing address

3125 COFFEE ROAD SUITE 1
MODESTO CA
95355-1768
US

V. Phone/Fax

Practice location:
  • Phone: 209-529-2726
  • Fax: 209-529-7323
Mailing address:
  • Phone: 209-529-2726
  • Fax: 209-529-7323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number33416
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: