Provider Demographics
NPI:1861460735
Name:YAO, WEIPING (MD)
Entity Type:Individual
Prefix:
First Name:WEIPING
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:PO BOX 241011
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95241-9511
Mailing Address - Country:US
Mailing Address - Phone:209-339-7435
Mailing Address - Fax:209-339-7858
Practice Address - Street 1:1235 W VINE ST
Practice Address - Street 2:SUITE 22
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-5144
Practice Address - Country:US
Practice Address - Phone:209-334-8520
Practice Address - Fax:209-334-2109
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85432174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH75270Medicare UPIN