Provider Demographics
NPI:1417153958
Name:YEE, BARTLEY GORDON (DO)
Entity Type:Individual
Prefix:DR
First Name:BARTLEY
Middle Name:GORDON
Last Name:YEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:309 E 2ND ST
Mailing Address - Street 2:HPC 2ND FLOOR, ROOM 2255
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-1854
Mailing Address - Country:US
Mailing Address - Phone:909-469-6753
Mailing Address - Fax:909-706-3780
Practice Address - Street 1:795 E 2ND ST
Practice Address - Street 2:SUITE 5
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-2007
Practice Address - Country:US
Practice Address - Phone:909-865-2565
Practice Address - Fax:909-865-2599
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A5152207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC695ZOtherMEDICARE NO CA PTAN
CADC695YOtherMEDICARE SO CA PTAN
CAF19578Medicare UPIN