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General NPI Number Information
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NPI Number | 1881919439
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Entity Type | Individual
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Provider Name | GRACE INNAE YI D.D.S
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Gender | Female
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Dates
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Enumeration Date | 04/06/2010
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 1428 LEXINGTON AVE APT # 4B
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City | NEW YORK
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State | NY
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Zip | 10128-1645
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Country | US
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Telephone | 510-846-4672
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Fax |
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Provider Business Mailing Address
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Address Line | 30 GOLF CLUB RD STE C
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City | PLEASANT HILL
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State | CA
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Zip | 94523-1569
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Country | US
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Telephone | 510-846-4672
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Fax | 925-685-8634
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DI02437300
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License Number State | NJ
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