MEDICARE: JU YON SOPHIE YI, MD, DDS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)
2	261QS0112X	Oral and Maxillofacial Surgery Clinic/Center

General Provider Information

NPI Number	:	1164361614
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JU YON SOPHIE YI, MD, DDS, PLLC

Provider Business Mailing Address
First Line	:	450 NW GILMAN BLVD STE 101
Second Line	:
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-2483
Country	:	US
Telephone Number	:	415-531-1448
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 NW GILMAN BLVD STE 101
Second Line	:
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-2483
Country	:	US
Telephone Number	:	426-961-9600
Fax Number	:	425-961-9601

Authorized Official
Title or Position	:	OWNER
Name	:	JU YON YI
Credential	:	MD, DDS
Telephone Number	:	415-531-1448

Provider Enumeration Date	:	03/27/2026
Last Update Date	:	03/27/2026

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