Provider Demographics
NPI:1508918699
Name:SOE, PYI (DDS)
Entity Type:Individual
Prefix:DR
First Name:PYI
Middle Name:
Last Name:SOE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17540 YORBA LINDA BLVD
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-3825
Mailing Address - Country:US
Mailing Address - Phone:714-996-4057
Mailing Address - Fax:714-996-4158
Practice Address - Street 1:17540 YORBA LINDA BLVD
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-3825
Practice Address - Country:US
Practice Address - Phone:714-996-4057
Practice Address - Fax:714-996-4158
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD46973122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist