=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164361614
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JU YON SOPHIE YI, MD, DDS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2026
-----------------------------------------------------
Last Update Date | 03/27/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 450 NW GILMAN BLVD STE 101
-----------------------------------------------------
City | ISSAQUAH
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98027-2483
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 426-961-9600
-----------------------------------------------------
Fax | 425-961-9601
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 450 NW GILMAN BLVD STE 101
-----------------------------------------------------
City | ISSAQUAH
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98027-2483
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-531-1448
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JU YON YI
-----------------------------------------------------
Credential | MD, DDS
-----------------------------------------------------
Telephone | 415-531-1448
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QS0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------