Provider Demographics
NPI:1457630808
Name:YI, SOPHIA C (DDS)
Entity Type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:C
Last Name:YI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 GOLD STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:WEST COLLINGSWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08107-1729
Practice Address - Country:US
Practice Address - Phone:856-854-1509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0412111223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry