Provider Demographics
NPI:1053325647
Name:YAO, ALAN C (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:C
Last Name:YAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13633 37TH AVE 7TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4561
Mailing Address - Country:US
Mailing Address - Phone:718-321-3262
Mailing Address - Fax:718-321-3263
Practice Address - Street 1:13633 37TH AVE 7TH FLOOR
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4561
Practice Address - Country:US
Practice Address - Phone:718-321-3262
Practice Address - Fax:718-321-3263
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204609207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02163642Medicaid
NY07932GMedicare ID - Type Unspecified
NY02163642Medicaid