Healthcare Provider Details

I. General information

NPI: 1679533574
Provider Name (Legal Business Name): MARY YEE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 CESAR CHAVEZ ST
SAINT PAUL MN
55107-2226
US

IV. Provider business mailing address

470 HARBOR CIR
SHOREVIEW MN
55126-1934
US

V. Phone/Fax

Practice location:
  • Phone: 651-222-1816
  • Fax: 651-602-7517
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35171
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: