Healthcare Provider Details

I. General information

NPI: 1689037376
Provider Name (Legal Business Name): STEPHEN YAU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 BROADWAY
CHULA VISTA CA
91910-4320
US

IV. Provider business mailing address

429 BROADWAY
CHULA VISTA CA
91910-4320
US

V. Phone/Fax

Practice location:
  • Phone: 619-434-0204
  • Fax: 619-337-0191
Mailing address:
  • Phone: 196-434-0204
  • Fax: 619-337-0191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number151069
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: