Basic Information
Provider Information
NPI: 1952317604
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BAO
FirstName: YERAN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: DEPT 34929
Address2: P.O. BOX 39000
City: SAN FRANCISCO
State: CA
PostalCode: 941390001
CountryCode: US
TelephoneNumber: 9259522828
FaxNumber: 9259522850
Practice Location
Address1: 1220 ROSSMOOR PKWY
Address2:  
City: WALNUT CREEK
State: CA
PostalCode: 945952501
CountryCode: US
TelephoneNumber: 9259391220
FaxNumber: 9259887584
Other Information
ProviderEnumerationDate: 08/01/2006
LastUpdateDate: 02/07/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RG0300XA81228CAN Allopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
207RE0101XA81228CAY Allopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism

No ID Information.


Home