Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DE00006243 | WA |
NPI | 1073500534 |
---|---|
Provider Name | Dr. John J Yae |
First Address | Lynnwood, WA 98036-4568 |
Second Address | Lynnwood, WA 98036-4568 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2005 |
Last Update Date | 08/03/2019 |