Provider Demographics
NPI:1174685218
Name:YAO, YIZHONG (LAC)
Entity Type:Individual
Prefix:
First Name:YIZHONG
Middle Name:
Last Name:YAO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:YIZHONG
Other - Last Name:YAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:20410 TOWN CENTER LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3229
Mailing Address - Country:US
Mailing Address - Phone:408-873-1273
Mailing Address - Fax:
Practice Address - Street 1:20410 TOWN CENTER LN
Practice Address - Street 2:SUITE 101
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-3229
Practice Address - Country:US
Practice Address - Phone:408-873-1273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5228171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0052281Medicaid