Provider Demographics
NPI:1710339023
Name:YI, BRIAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:YI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13788 ROSWELL AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-1414
Mailing Address - Country:US
Mailing Address - Phone:909-464-2008
Mailing Address - Fax:909-287-7705
Practice Address - Street 1:13788 ROSWELL AVE STE 106
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-1414
Practice Address - Country:US
Practice Address - Phone:909-464-2008
Practice Address - Fax:909-287-7705
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006764213E00000X
CAE5598213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist