Provider Demographics
NPI:1598882433
Name:YI, KAIN (DDS)
Entity Type:Individual
Prefix:
First Name:KAIN
Middle Name:
Last Name:YI
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 1:1111 CIVIC DR STE 145
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-8229
Mailing Address - Country:US
Mailing Address - Phone:925-937-9017
Mailing Address - Fax:
Practice Address - Street 1:1111 CIVIC DR STE 145
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-8229
Practice Address - Country:US
Practice Address - Phone:925-937-9017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA506121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice