Provider Demographics
NPI:1730281106
Name:YI, JOHANN M (DDS)
Entity Type:Individual
Prefix:
First Name:JOHANN
Middle Name:M
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 1:1515 116TH AVE NE
Mailing Address - Street 2:#206
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004
Mailing Address - Country:US
Mailing Address - Phone:425-454-1225
Mailing Address - Fax:425-454-3662
Practice Address - Street 1:1515 116TH AVE NE
Practice Address - Street 2:#206
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004
Practice Address - Country:US
Practice Address - Phone:425-454-1225
Practice Address - Fax:425-454-3662
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA8211122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist