Provider Demographics
NPI:1336409481
Name:ORT, YIRAE (DDS)
Entity Type:Individual
Prefix:
First Name:YIRAE
Middle Name:
Last Name:ORT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 116TH AVE NE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3800
Mailing Address - Country:US
Mailing Address - Phone:425-200-5890
Mailing Address - Fax:425-589-0560
Practice Address - Street 1:1260 116TH AVE NE
Practice Address - Street 2:SUITE 110
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3800
Practice Address - Country:US
Practice Address - Phone:425-200-5890
Practice Address - Fax:425-589-0560
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME132729204E00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program