Provider Demographics
NPI:1417301375
Name:YAO, YUAN
Entity Type:Individual
Prefix:
First Name:YUAN
Middle Name:
Last Name:YAO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 58TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3609
Mailing Address - Country:US
Mailing Address - Phone:718-686-8888
Mailing Address - Fax:718-290-2913
Practice Address - Street 1:833 58TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3609
Practice Address - Country:US
Practice Address - Phone:718-686-8888
Practice Address - Fax:711-290-2913
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301215207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine