Healthcare Provider Details

I. General information

NPI: 1770870180
Provider Name (Legal Business Name): ALICE JI-SHAN YAU D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2011
Last Update Date: 12/02/2021
Certification Date: 12/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25965 NORMANDIE AVE OBSTETRICS & GYNECOLOGY DEPARTMENT
HARBOR CITY CA
90710-3416
US

IV. Provider business mailing address

25965 NORMANDIE AVE OBSTETRICS & GYNECOLOGY DEPARTMENT
HARBOR CITY CA
90710-3416
US

V. Phone/Fax

Practice location:
  • Phone: 800-780-1230
  • Fax:
Mailing address:
  • Phone: 800-780-1230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number20A12706
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: