Provider Demographics
NPI:1699269522
Name:YI, JESSICA HAEUN (DMD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:HAEUN
Last Name:YI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 ROUTE 70 E STE 9
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2123
Mailing Address - Country:US
Mailing Address - Phone:856-938-1085
Mailing Address - Fax:
Practice Address - Street 1:1910 ROUTE 70 E STE 9
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2123
Practice Address - Country:US
Practice Address - Phone:856-938-1085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0420411223P0221X
NJ22DI027949001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry