Healthcare Provider Details

I. General information

NPI: 1982190088
Provider Name (Legal Business Name): LUCILLE Y YAO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: YUKUN YAO

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD STE 8215NT
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

8700 BEVERLY BLVD STE 8215NT
WEST HOLLYWOOD CA
90048-1804
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-6637
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number036177039
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: