Healthcare Provider Details

I. General information

NPI: 1760604003
Provider Name (Legal Business Name): THEODORE T YEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 12/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1438 LAYMAN ST
MC LEAN VA
22101-3128
US

IV. Provider business mailing address

1438 LAYMAN ST
MC LEAN VA
22101-3128
US

V. Phone/Fax

Practice location:
  • Phone: 626-226-7412
  • Fax:
Mailing address:
  • Phone: 626-226-7412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA73598
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberA73598
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: