Provider Demographics
NPI:1417077967
Name:YU YAO MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:YU YAO MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WINNIE
Authorized Official - Middle Name:XU
Authorized Official - Last Name:YAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-288-1918
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A553700Medicaid
CAA55370Medicare ID - Type Unspecified
CAG30209Medicare UPIN