Provider Demographics
NPI:1083600407
Name:YAO, JIAMING (NP)
Entity Type:Individual
Prefix:
First Name:JIAMING
Middle Name:
Last Name:YAO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13426 35TH AVE
Mailing Address - Street 2:APT. 1
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-2895
Mailing Address - Country:US
Mailing Address - Phone:646-344-9703
Mailing Address - Fax:
Practice Address - Street 1:3907 PRINCE ST
Practice Address - Street 2:SUITE 3A
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5399
Practice Address - Country:US
Practice Address - Phone:718-661-1783
Practice Address - Fax:718-661-1772
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334194363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ24745Medicare UPIN
NY06578HMedicare ID - Type Unspecified