MEDICARE: DR. YISI DAISY JI MD, 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	D12107	OR
2	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	DEN-206593	CO
3	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	MD216829	OR
4	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	DN1859258	MA

General Provider Information

NPI Number	:	1518452705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YISI DAISY JI MD, DMD

Provider Business Mailing Address
First Line	:	250 CHURCH ST SE STE 102
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-3758
Country	:	US
Telephone Number	:	503-581-1999
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 CHURCH ST SE STE 102
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-3758
Country	:	US
Telephone Number	:	503-581-1999
Fax Number	:

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

Provider Enumeration Date	:	06/29/2018
Last Update Date	:	06/08/2026

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