Provider Demographics
NPI:1760480651
Name:YAO, SHOUNAN (MD)
Entity Type:Individual
Prefix:
First Name:SHOUNAN
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 1:416 W. LAS TUNAS, #105
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776
Mailing Address - Country:US
Mailing Address - Phone:626-284-2000
Mailing Address - Fax:626-284-4300
Practice Address - Street 1:416 W. LAS TUNAS, #105
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776
Practice Address - Country:US
Practice Address - Phone:626-284-2000
Practice Address - Fax:626-284-4300
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83484207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000290957OtherANTHEM
OH287922561001OtherMEDICAL MUTUAL
OH1001188OtherUHC
CA00A83484AOtherMEDI-CAL
OH2130422OtherFIRST HEALTH
OH2411241Medicaid
OHH88517Medicare UPIN
OHYA4111011Medicare ID - Type Unspecified