Healthcare Provider Details

I. General information

NPI: 1710499975
Provider Name (Legal Business Name): JENNIE YEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2017
Last Update Date: 10/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 HARRISON ST FL 13
OAKLAND CA
94612-3466
US

IV. Provider business mailing address

1800 HARRISON ST FL 13
OAKLAND CA
94612-3466
US

V. Phone/Fax

Practice location:
  • Phone: 510-625-5232
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number54659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: