Provider Demographics
NPI:1366798134
Name:YEE, CRYSTAL
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:YEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 PACIFICA STE 340
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3329
Mailing Address - Country:US
Mailing Address - Phone:949-390-9010
Mailing Address - Fax:949-331-1445
Practice Address - Street 1:114 PACIFICA STE 340
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3329
Practice Address - Country:US
Practice Address - Phone:949-390-9010
Practice Address - Fax:949-331-1445
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ7517208000000X
390200000X
CAA132768208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty