Healthcare Provider Details

I. General information

NPI: 1578601050
Provider Name (Legal Business Name): YILI CAO YILI CAO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 SOUTH ST SUITE 101
WALTHAM MA
02453-3594
US

IV. Provider business mailing address

74 CHRISTOPHER RD
WALTHAM MA
02451-1312
US

V. Phone/Fax

Practice location:
  • Phone: 781-891-0670
  • Fax:
Mailing address:
  • Phone: 781-890-8688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number345
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: