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General NPI Number Information
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NPI Number | 1437435906
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Entity Type | Organization
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Legal Business Name | YI DENTAL, DMD, PC
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Dates
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Enumeration Date | 10/28/2011
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Last Update Date | 12/16/2011
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Provider Practice Location Address
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Address Line | 1300 S WATSON RD SUITE A-100
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City | BUCKEYE
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State | AZ
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Zip | 85326-6303
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Country | US
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Telephone | 623-386-3333
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Fax | 623-386-3544
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Provider Business Mailing Address
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Address Line | 1300 S WATSON RD SUITE A-100
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City | BUCKEYE
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State | AZ
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Zip | 85326-6303
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Country | US
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Telephone | 623-386-3333
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Fax | 623-386-3544
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KYONG H YI
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Credential | DMD
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Telephone | 623-386-3333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6436
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License Number State | AZ
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