Provider Demographics
NPI:1417183187
Name:YIAN, MICHELE LEE (DMD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:LEE
Last Name:YIAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SUPREMA DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT COAST
Mailing Address - State:CA
Mailing Address - Zip Code:92657-1512
Mailing Address - Country:US
Mailing Address - Phone:650-814-8625
Mailing Address - Fax:
Practice Address - Street 1:9 SUPREMA DR
Practice Address - Street 2:
Practice Address - City:NEWPORT COAST
Practice Address - State:CA
Practice Address - Zip Code:92657-1512
Practice Address - Country:US
Practice Address - Phone:650-814-8625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.028239122300000X
CA61646122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist