Healthcare Provider Details

I. General information

NPI: 1861680555
Provider Name (Legal Business Name): JOANNA YAO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LI YAO

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3090 BRISTOL ST STE 200
COSTA MESA CA
92626-3061
US

IV. Provider business mailing address

3090 BRISTOL ST STE 200
COSTA MESA CA
92626-3061
US

V. Phone/Fax

Practice location:
  • Phone: 888-789-9585
  • Fax: 562-803-4500
Mailing address:
  • Phone: 888-789-9585
  • Fax: 562-803-4500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17458
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: