Provider Demographics
NPI:1326713298
Name:CARDENAS, YESENIA SHAO
Entity Type:Individual
Prefix:
First Name:YESENIA
Middle Name:SHAO
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4004 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-3836
Mailing Address - Country:US
Mailing Address - Phone:408-807-9065
Mailing Address - Fax:
Practice Address - Street 1:4004 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148-3836
Practice Address - Country:US
Practice Address - Phone:408-807-9065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program