Healthcare Provider Details

I. General information

NPI: 1093132524
Provider Name (Legal Business Name): YAO MA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2014
Last Update Date: 10/29/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N STATE ST. CLINIC TOWER A7E
LOS ANGELES CA
90033
US

IV. Provider business mailing address

1100 N STATE ST. CLINIC TOWER A7E
LOS ANGELES CA
90033
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-7159
  • Fax:
Mailing address:
  • Phone: 323-409-7159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License NumberR4589
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License NumberA127935
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA127935
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberR4589
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: