Provider Demographics
NPI:1558896241
Name:YAO, SAN LAW (RPH)
Entity Type:Individual
Prefix:
First Name:SAN
Middle Name:LAW
Last Name:YAO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 DUDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94611-3439
Mailing Address - Country:US
Mailing Address - Phone:510-414-8330
Mailing Address - Fax:510-752-4185
Practice Address - Street 1:3701 BROADWAY
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5613
Practice Address - Country:US
Practice Address - Phone:510-752-4184
Practice Address - Fax:510-752-4185
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41291183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
41291OtherPHARMACIST