Healthcare Provider Details

I. General information

NPI: 1801506365
Provider Name (Legal Business Name): JORDAN K YEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2022
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4235 MAIN ST
FLUSHING NY
11355-3956
US

IV. Provider business mailing address

14480 SANFORD AVE APT 5J
FLUSHING NY
11355-6303
US

V. Phone/Fax

Practice location:
  • Phone: 718-878-6999
  • Fax: 718-939-8838
Mailing address:
  • Phone: 646-361-9036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberI069929
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: