Provider Demographics
NPI:1225455165
Name:YAO, TIBECA (CBS)
Entity Type:Individual
Prefix:
First Name:TIBECA
Middle Name:
Last Name:YAO
Suffix:
Gender:F
Credentials:CBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 ENSOR AVE
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-2310
Mailing Address - Country:US
Mailing Address - Phone:708-691-3463
Mailing Address - Fax:
Practice Address - Street 1:26 ENSOR AVE
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-2310
Practice Address - Country:US
Practice Address - Phone:708-691-3463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist