Healthcare Provider Details

I. General information

NPI: 1932305679
Provider Name (Legal Business Name): NANCY JEN YEE D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 ARIZONA AVE
SANTA MONICA CA
90401-1655
US

IV. Provider business mailing address

620 ARIZONA AVE
SANTA MONICA CA
90401-1655
US

V. Phone/Fax

Practice location:
  • Phone: 310-395-7221
  • Fax: 310-237-5863
Mailing address:
  • Phone: 310-395-7221
  • Fax: 310-237-5863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number32209
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: