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General NPI Number Information
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NPI Number | 1588084289
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Entity Type | Organization
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Legal Business Name | STEPHANIE YI DDS LLC
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Dates
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Enumeration Date | 04/21/2014
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Last Update Date | 04/21/2014
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Provider Practice Location Address
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Address Line | 1717 S 324TH ST SUITE A
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City | FEDERAL WAY
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State | WA
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Zip | 98003-8500
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Country | US
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Telephone | 253-815-0093
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Fax |
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Provider Business Mailing Address
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Address Line | 1717 S 324TH ST SUITE A
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City | FEDERAL WAY
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State | WA
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Zip | 98003-8500
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | STEPHANIE YI
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Credential | DDS
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Telephone | 206-954-0523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE00011050
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License Number State | WA
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