Healthcare Provider Details

I. General information

NPI: 1558304352
Provider Name (Legal Business Name): TIMOTHY YAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 FLORIDA AVE
MODESTO CA
95350-4405
US

IV. Provider business mailing address

1441 FLORIDA AVE
MODESTO CA
95350-4405
US

V. Phone/Fax

Practice location:
  • Phone: 209-576-3710
  • Fax: 209-576-3592
Mailing address:
  • Phone: 209-576-3710
  • Fax: 209-576-3592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberG73286
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: