Provider Demographics
NPI:1881919439
Name:YI, GRACE INNAE (DDS)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:INNAE
Last Name:YI
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 1:30 GOLF CLUB RD STE C
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-1569
Mailing Address - Country:US
Mailing Address - Phone:510-846-4672
Mailing Address - Fax:925-685-8634
Practice Address - Street 1:1428 LEXINGTON AVE
Practice Address - Street 2:APT # 4B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1645
Practice Address - Country:US
Practice Address - Phone:510-846-4672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI024373001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice