Healthcare Provider Details

I. General information

NPI: 1790878551
Provider Name (Legal Business Name): GENNIE YEE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 OLD NEWPORT BLVD STE 200
NEWPORT BEACH CA
92663-4252
US

IV. Provider business mailing address

415 OLD NEWPORT BLVD STE 200
NEWPORT BEACH CA
92663-4252
US

V. Phone/Fax

Practice location:
  • Phone: 949-548-9611
  • Fax: 949-548-9958
Mailing address:
  • Phone: 949-548-9611
  • Fax: 949-548-9958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA96040
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA96040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: