Provider Demographics
NPI:1619169638
Name:YI, MICHELE (MD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:YI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11102 SUNRISE BLVD E
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374
Mailing Address - Country:US
Mailing Address - Phone:253-848-8797
Mailing Address - Fax:253-845-0100
Practice Address - Street 1:10004 204TH AVE E
Practice Address - Street 2:SUITE 1300
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391
Practice Address - Country:US
Practice Address - Phone:253-848-8797
Practice Address - Fax:253-845-0100
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA60078044208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics