Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 51004 | CA |
Y | 1223P0300X | Periodontist | 51004 | CA |
NPI | 1134323660 |
---|---|
Provider Name | Klaus M Yi |
First Address | Rancho Mirage, CA 92270-1727 |
Second Address | Rancho Mirage, CA 92270-1727 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2007 |
Last Update Date | 10/07/2015 |