Healthcare Provider Details

I. General information

NPI: 1386934693
Provider Name (Legal Business Name): CHENGYIN YAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 WEST SAGINAW STREET
LANSING MI
48915-1966
US

IV. Provider business mailing address

1019 WEST SAGINAW STREET
LANSING MI
48915-1966
US

V. Phone/Fax

Practice location:
  • Phone: 517-374-6103
  • Fax:
Mailing address:
  • Phone: 517-374-6103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302035404
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH.03230751-2
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: