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General NPI Number Information
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NPI Number | 1518452705
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Entity Type | Individual
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Provider Name | YISI DAISY JI MD, DMD
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Gender | Female
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Dates
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Enumeration Date | 06/29/2018
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Last Update Date | 05/24/2025
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Provider Practice Location Address
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Address Line | 250 CHURCH ST SE STE 102
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City | SALEM
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State | OR
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Zip | 97301-3758
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Country | US
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Telephone | 503-581-1999
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Fax |
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Provider Business Mailing Address
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Address Line | 250 CHURCH ST SE STE 102
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City | SALEM
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State | OR
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Zip | 97301-3758
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Country | US
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Telephone | 503-581-1999
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | D12107
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | DN1859258
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | MD216829
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License Number State | OR
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