Healthcare Provider Details

I. General information

NPI: 1346222718
Provider Name (Legal Business Name): JAMES H YAO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIR
TRAVIS AFB CA
94535-1809
US

IV. Provider business mailing address

3309 WHITEMARSH LN
FAIRFIELD CA
94534-7135
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-7083
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDS030471L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: