Provider Demographics
NPI:1518452705
Name:JI, YISI DAISY (MD, DMD)
Entity type:Individual
Prefix:DR
First Name:YISI
Middle Name:DAISY
Last Name:JI
Suffix:
Gender:F
Credentials:MD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 CHURCH ST SE STE 102
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3758
Mailing Address - Country:US
Mailing Address - Phone:503-581-1999
Mailing Address - Fax:
Practice Address - Street 1:250 CHURCH ST SE STE 102
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3758
Practice Address - Country:US
Practice Address - Phone:503-581-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2025-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD121071223S0112X
MADN1859258204E00000X
ORMD216829204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery