Healthcare Provider Details

I. General information

NPI: 1629136080
Provider Name (Legal Business Name): WINSTON F YEE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17760 HESPERIAN BLVD
SAN LORENZO CA
94580
US

IV. Provider business mailing address

17760 HESPERIAN BLVD
SAN LORENZO CA
94580
US

V. Phone/Fax

Practice location:
  • Phone: 510-276-8760
  • Fax: 510-276-8782
Mailing address:
  • Phone: 510-276-8760
  • Fax: 510-276-8782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number25657
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: