Healthcare Provider Details

I. General information

NPI: 1588306625
Provider Name (Legal Business Name): KEVIN YAO MD MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2022
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 W LAS TUNAS DR UNIT 201
SAN GABRIEL CA
91776-1133
US

IV. Provider business mailing address

533 W LAS TUNAS DR UNIT 201
SAN GABRIEL CA
91776-1133
US

V. Phone/Fax

Practice location:
  • Phone: 626-284-2000
  • Fax:
Mailing address:
  • Phone: 626-284-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1588306625
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: