Healthcare Provider Details

I. General information

NPI: 1639701329
Provider Name (Legal Business Name): CHRISTINE YEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2020
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12759 FOOTHILL BLVD STE C
RANCHO CUCAMONGA CA
91739-9336
US

IV. Provider business mailing address

315 GREENBERRY DR
LA PUENTE CA
91744-3743
US

V. Phone/Fax

Practice location:
  • Phone: 909-899-0026
  • Fax:
Mailing address:
  • Phone: 626-423-9181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number34535
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: