Healthcare Provider Details

I. General information

NPI: 1649630948
Provider Name (Legal Business Name): YOO-LEE YEA DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2016
Last Update Date: 02/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18807 BEARDSLEE BLVD SUITE 103
BOTHELL WA
98011-1712
US

IV. Provider business mailing address

18807 BEARDSLEE BLVD SUITE 103
BOTHELL WA
98011-1712
US

V. Phone/Fax

Practice location:
  • Phone: 425-486-6300
  • Fax: 425-487-6498
Mailing address:
  • Phone: 425-486-6300
  • Fax: 425-487-6498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDE00009955
License Number StateWA

VIII. Authorized Official

Name: DR. YOO-LEE YEA
Title or Position: PEDIATRIC DENTIST
Credential: DDS MSD MPH
Phone: 206-852-7338