Healthcare Provider Details

I. General information

NPI: 1346801578
Provider Name (Legal Business Name): YI LING DAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 SOUTH BLVD E STE 180
ROCHESTER HILLS MI
48307-6115
US

IV. Provider business mailing address

33080 UTICA RD STE B
FRASER MI
48026-2038
US

V. Phone/Fax

Practice location:
  • Phone: 248-293-5161
  • Fax: 248-564-2954
Mailing address:
  • Phone: 862-967-2505
  • Fax: 586-944-2315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4301511300
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4352000982
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number1014825
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: