Provider Demographics
NPI:1427028968
Name:YAO, JIM (MD)
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:
Last Name:YAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:210 S DESPLAINES ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-5500
Mailing Address - Country:US
Mailing Address - Phone:312-654-2700
Mailing Address - Fax:312-654-9930
Practice Address - Street 1:314 RIDGE RD
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1528
Practice Address - Country:US
Practice Address - Phone:219-789-1169
Practice Address - Fax:219-836-9364
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2023-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01061528A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I10373Medicare UPIN