Healthcare Provider Details

I. General information

NPI: 1790825693
Provider Name (Legal Business Name): JERRY C S YAO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 CONTRA COSTA BLVD SUITE 303
PLEASANT HILL CA
94523
US

IV. Provider business mailing address

2255 CONTRA COSTA BLVD SUITE 303
PLEASANT HILL CA
94523
US

V. Phone/Fax

Practice location:
  • Phone: 925-676-7310
  • Fax: 925-676-3170
Mailing address:
  • Phone: 925-676-7310
  • Fax: 925-676-3170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number37047
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: