Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 036047145 | IL |
Y | 208D00000X | General Practice Physician | 036047145 | IL |
NPI | 1043220742 |
---|---|
Provider Name | Dr. Tito G Yao |
First Address | Oak Brook, IL 60523-2561 |
Second Address | Chicago, IL 60651-2903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2006 |
Last Update Date | 27/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036047145 | (05) | IL |
C43235 | (02) |