Healthcare Provider Details

I. General information

NPI: 1174689160
Provider Name (Legal Business Name): JOHN M YEE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 08 JUSTICE AVENUE STE 2B
ELMHURST NY
11373
US

IV. Provider business mailing address

87 08 JUSTICE AVENUE STE 2B
ELMHURST NY
11373
US

V. Phone/Fax

Practice location:
  • Phone: 718-639-8882
  • Fax: 718-639-8959
Mailing address:
  • Phone: 718-639-8882
  • Fax: 718-639-8959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number041235
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: