Provider Demographics
NPI:1982655858
Name:RUO, YIJAN (MD)
Entity Type:Individual
Prefix:DR
First Name:YIJAN
Middle Name:
Last Name:RUO
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 1:7171 BOWLING DR STE 300
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2043
Mailing Address - Country:US
Mailing Address - Phone:916-875-0802
Mailing Address - Fax:
Practice Address - Street 1:7171 BOWLING DR
Practice Address - Street 2:STE 300
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823
Practice Address - Country:US
Practice Address - Phone:916-875-0802
Practice Address - Fax:916-875-0854
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73664207R00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
F72586Medicare UPIN