Healthcare Provider Details

I. General information

NPI: 1306645866
Provider Name (Legal Business Name): JUSTIN YI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10750 QUEENS BLVD
FOREST HILLS NY
11375-4266
US

IV. Provider business mailing address

2323 31ST AVE APT 2A
ASTORIA NY
11106-4073
US

V. Phone/Fax

Practice location:
  • Phone: 718-793-1777
  • Fax:
Mailing address:
  • Phone: 410-978-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number065769
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: