Provider Demographics
NPI:1477174779
Name:JUE, STEPHANIE HUE YEE
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:HUE YEE
Last Name:JUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9822 CAMELOT ST
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-8571
Mailing Address - Country:US
Mailing Address - Phone:770-722-7921
Mailing Address - Fax:
Practice Address - Street 1:878 EASTLAKE PKWY STE 1511
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-4550
Practice Address - Country:US
Practice Address - Phone:619-739-4936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC390200000X
CA1101201223E0200X
MADN1858893122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No122300000XDental ProvidersDentist