Healthcare Provider Details

I. General information

NPI: 1861460735
Provider Name (Legal Business Name): WEIPING YAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 04/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 W VINE ST SUITE 22
LODI CA
95240-5144
US

IV. Provider business mailing address

PO BOX 241011
LODI CA
95241-9511
US

V. Phone/Fax

Practice location:
  • Phone: 209-334-8520
  • Fax: 209-334-2109
Mailing address:
  • Phone: 209-339-7435
  • Fax: 209-339-7858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA85432
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: