Healthcare Provider Details

I. General information

NPI: 1164681938
Provider Name (Legal Business Name): ELISA YAO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 SHOWERS DR STE 7-212
MOUNTAIN VIEW CA
94040-4740
US

IV. Provider business mailing address

530 SHOWERS DR STE 7-212
MOUNTAIN VIEW CA
94040-4740
US

V. Phone/Fax

Practice location:
  • Phone: 650-476-9193
  • Fax: 430-206-1884
Mailing address:
  • Phone: 650-476-9193
  • Fax: 430-206-1884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA105320
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: