Healthcare Provider Details

I. General information

NPI: 1780290908
Provider Name (Legal Business Name): PHILLIP YAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2020
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 GOLDEN SHR STE 350
LONG BEACH CA
90802-4279
US

IV. Provider business mailing address

13936 S BROADWAY
LOS ANGELES CA
90061-1016
US

V. Phone/Fax

Practice location:
  • Phone: 888-588-8995
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number141843
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: