Provider Demographics
NPI:1457391708
Name:YAO, RUIJIN (MD)
Entity type:Individual
Prefix:DR
First Name:RUIJIN
Middle Name:
Last Name:YAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14122 CHINKAPIN DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850
Mailing Address - Country:US
Mailing Address - Phone:301-908-4613
Mailing Address - Fax:
Practice Address - Street 1:14816 PHYSICIANS LN
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3937
Practice Address - Country:US
Practice Address - Phone:301-251-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0059782174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405184000Medicaid
MDH28976Medicare UPIN
MD405184000Medicaid