Healthcare Provider Details

I. General information

NPI: 1205021565
Provider Name (Legal Business Name): WAYNE J YEE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E 64TH ST OFC #1
NEW YORK NY
10065-7041
US

IV. Provider business mailing address

125 E 64TH ST #1
NEW YORK NY
10065-7041
US

V. Phone/Fax

Practice location:
  • Phone: 212-734-7508
  • Fax: 212-734-7549
Mailing address:
  • Phone: 212-734-7508
  • Fax: 212-734-7549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number045172
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: