MEDICARE: DR. JU YON SOPHIE YI MD, DDS

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	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	MD.MD.60287405	WA
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DENT.DE.60286345	WA
3	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	MD.MD.60287405	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447461173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JU YON SOPHIE YI MD, DDS

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	:	425-961-9600
Fax Number	:	425-961-9601

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	:	425-961-9600
Fax Number	:	425-961-9601

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	03/27/2026

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Directions to “ DR. JU YON SOPHIE YI MD, DDS” Practice Location

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