Healthcare Provider Details

I. General information

NPI: 1962594226
Provider Name (Legal Business Name): JERRY NING YEE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11803 W NORTH AVE
WAYWATOSA WI
53226
US

IV. Provider business mailing address

11803 W NORTH AVE
WAYWATOSA WI
53226
US

V. Phone/Fax

Practice location:
  • Phone: 414-258-5522
  • Fax: 414-258-1337
Mailing address:
  • Phone: 414-258-5522
  • Fax: 414-258-1337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number18823021
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: