Provider Demographics
NPI:1356307821
Name:YAO, YU (MD)
Entity Type:Individual
Prefix:
First Name:YU
Middle Name:
Last Name:YAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:YU
Other - Middle Name:
Other - Last Name:YAO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:230 E VALLEY BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-6510
Mailing Address - Country:US
Mailing Address - Phone:626-288-1918
Mailing Address - Fax:626-288-0796
Practice Address - Street 1:230 E VALLEY BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-6507
Practice Address - Country:US
Practice Address - Phone:626-288-1918
Practice Address - Fax:626-288-0796
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55370207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A553700Medicaid
CAA55370Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
CAG30209Medicare UPIN