Healthcare Provider Details

I. General information

NPI: 1043220742
Provider Name (Legal Business Name): TITO G YAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 09/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5140 W CHICAGO AVE GSK MEDICAL CENTER
CHICAGO IL
60651-2903
US

IV. Provider business mailing address

322 TRINITY LN
OAK BROOK IL
60523-2561
US

V. Phone/Fax

Practice location:
  • Phone: 773-287-0751
  • Fax: 773-287-0451
Mailing address:
  • Phone: 773-287-0751
  • Fax: 773-287-0451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036047145
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number036047145
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: