Healthcare Provider Details

I. General information

NPI: 1760480651
Provider Name (Legal Business Name): SHOUNAN YAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 W LAS TUNAS DR # 202
SAN GABRIEL CA
91776-1133
US

IV. Provider business mailing address

533 W LAS TUNAS DR # 202
SAN GABRIEL CA
91776-1133
US

V. Phone/Fax

Practice location:
  • Phone: 626-284-2000
  • Fax: 626-284-4300
Mailing address:
  • Phone: 626-284-2000
  • Fax: 626-284-4300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberA83484
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: