Provider Demographics
NPI:1518951649
Name:YAO, WAN (MD)
Entity Type:Individual
Prefix:
First Name:WAN
Middle Name:
Last Name:YAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 N GARFIELD AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1709
Mailing Address - Country:US
Mailing Address - Phone:626-288-3219
Mailing Address - Fax:888-349-7157
Practice Address - Street 1:228 N GARFIELD AVE STE 302
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1709
Practice Address - Country:US
Practice Address - Phone:626-288-3219
Practice Address - Fax:888-349-7157
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-05
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77060207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A770601Medicaid
W16911Medicare ID - Type Unspecified
CA00A770601Medicaid