Healthcare Provider Details

I. General information

NPI: 1275244774
Provider Name (Legal Business Name): SIMON STEPHEN LEE YAO NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 12/30/2024
Certification Date: 03/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

867 S TUSTIN ST
ORANGE CA
92866-3426
US

IV. Provider business mailing address

6533 PEACH BLOSSOM ST
EASTVALE CA
92880-0765
US

V. Phone/Fax

Practice location:
  • Phone: 714-771-1420
  • Fax:
Mailing address:
  • Phone: 909-816-6563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95023529
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: