Healthcare Provider Details

I. General information

NPI: 1073721585
Provider Name (Legal Business Name): KWOK-PING YAU LICAC DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RAYMOND KWOK YAU LICAC DMD

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 E INDIAN SCHOOL RD
PHX AZ
85016
US

IV. Provider business mailing address

2705 E INDIAN SCHOOL RD
PHX AZ
85016
US

V. Phone/Fax

Practice location:
  • Phone: 602-956-0941
  • Fax:
Mailing address:
  • Phone: 602-956-0941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0098
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberCS1597
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: