Provider Demographics
NPI:1982747846
Name:YEE, KELVIN K (MD)
Entity Type:Individual
Prefix:DR
First Name:KELVIN
Middle Name:K
Last Name:YEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KELVIN
Other - Middle Name:KOOK YIM
Other - Last Name:YEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:559 W LAS TUNAS DR
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-1134
Mailing Address - Country:US
Mailing Address - Phone:626-457-9618
Mailing Address - Fax:626-457-9242
Practice Address - Street 1:559 W LAS TUNAS DR
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-1134
Practice Address - Country:US
Practice Address - Phone:626-457-9618
Practice Address - Fax:626-457-9242
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34924207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G349240Medicaid
CAA46149Medicare ID - Type Unspecified