Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 53184 | CA |
Y | 1223X0400X | Orthodontists | DDS53184 | CA |
NPI | 1073599957 |
---|---|
Provider Name | Dr. Gia Kim Yi |
First Address | Brea, CA 92821-4548 |
Second Address | Brea, CA 92821-4548 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2005 |
Last Update Date | 30/08/2017 |