MEDICARE: DR. ANDREA ELIZABETH YALEY DMD

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	1223G0001X	General Practice Dentistry	63551	CA

General Provider Information

NPI Number	:	1497161541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREA ELIZABETH YALEY DMD

Provider Business Mailing Address
First Line	:	21121 50TH DR SE
Second Line	:
City	:	BOTHELL
State	:	WA
Zip	:	98021-7981
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	825 OAK GROVE AVE # 401
Second Line	:
City	:	MENLO PARK
State	:	CA
Zip	:	94025-4434
Country	:	US
Telephone Number	:	650-325-8030
Fax Number	:

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

Provider Enumeration Date	:	07/09/2014
Last Update Date	:	12/01/2021

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