Basic Information
| Provider Information | |||||||||
| NPI: | 1285678250 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YEH | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27121 174TH PL SE | ||||||||
| Address2: | STE 202 | ||||||||
| City: | COVINGTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2536389955 | ||||||||
| FaxNumber: | 5094543651 | ||||||||
| Practice Location | |||||||||
| Address1: | 27121 174TH PL SE | ||||||||
| Address2: | STE 202 | ||||||||
| City: | COVINGTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2536389955 | ||||||||
| FaxNumber: | 5094543651 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DE00010438 | WA | N | Dental Providers | Dentist | 1223G0001X | DE00010438 | WA | Y | Dental Providers | Dentist | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 5050174 | 05 | WA | MEDICAID |