Healthcare Provider Details

I. General information

NPI: 1609515477
Provider Name (Legal Business Name): JOSELYN MELISA YE TAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 LAWS AVE
UKIAH CA
95482-6540
US

IV. Provider business mailing address

PO BOX 102842
PASADENA CA
91189-0132
US

V. Phone/Fax

Practice location:
  • Phone: 707-468-1010
  • Fax: 707-462-7532
Mailing address:
  • Phone: 305-669-5873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA209638
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: