Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | A83484 | CA |
NPI | 1760480651 |
---|---|
Provider Name | Shounan Yao |
First Address | San Gabriel, CA 91776 |
Second Address | San Gabriel, CA 91776 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 12/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000290957 | ANTHEM (01) | OH |
00A83484A | MEDI-CAL (01) | CA |
1001188 | UHC (01) | OH |
2130422 | FIRST HEALTH (01) | OH |
2411241 | (05) | OH |
287922561001 | MEDICAL MUTUAL (01) | OH |
H88517 | (02) | OH |