Provider Demographics
NPI:1326634395
Name:YEH, CASSIE L
Entity Type:Individual
Prefix:
First Name:CASSIE
Middle Name:L
Last Name:YEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 HASTE ST APT 203
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2238
Mailing Address - Country:US
Mailing Address - Phone:949-864-9402
Mailing Address - Fax:
Practice Address - Street 1:1018 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4224
Practice Address - Country:US
Practice Address - Phone:510-893-5678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105804122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist