Provider Demographics
NPI:1144905316
Name:SALLY YI DDS CORP
Entity type:Organization
Organization Name:SALLY YI DDS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEUNG
Authorized Official - Middle Name:HUI
Authorized Official - Last Name:YI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-573-7214
Mailing Address - Street 1:17935 PASEO DEL SOL
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-3912
Mailing Address - Country:US
Mailing Address - Phone:909-573-7214
Mailing Address - Fax:
Practice Address - Street 1:460 N INDIAN HILL BLVD
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4613
Practice Address - Country:US
Practice Address - Phone:909-573-7214
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental