Healthcare Provider Details

I. General information

NPI: 1104567361
Provider Name (Legal Business Name): MAX YAO
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2022
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

679 S NEW HAMPSHIRE AVE STE 400
LOS ANGELES CA
90005-1355
US

IV. Provider business mailing address

500 S LAKE ST APT 314
LOS ANGELES CA
90057-2770
US

V. Phone/Fax

Practice location:
  • Phone: 213-639-2500
  • Fax:
Mailing address:
  • Phone: 408-691-0521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW133276
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: