Basic Information
| Provider Information | |||||||||
| NPI: | 1356307821 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YAO | ||||||||
| FirstName: | YU | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | YAO | ||||||||
| OtherFirstName: | YU | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 230 E VALLEY BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SAN GABRIEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917766510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262881918 | ||||||||
| FaxNumber: | 6262880796 | ||||||||
| Practice Location | |||||||||
| Address1: | 230 E VALLEY BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SAN GABRIEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917766507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262881918 | ||||||||
| FaxNumber: | 6262880796 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 01/26/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A55370 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A553700 | 05 | CA | MEDICAID |