Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | ME132729 | FL |
NPI | 1336409481 |
---|---|
Provider Name | Yirae Ort |
First Address | Bellevue, WA 98004-3800 |
Second Address | Bellevue, WA 98004-3800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2012 |
Last Update Date | 12/08/2019 |