Healthcare Provider Details

I. General information

NPI: 1861734543
Provider Name (Legal Business Name): MICHAEL VINCENT YAO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 LOMAS BLVD NE
ALBUQUERQUE NM
87106-2719
US

IV. Provider business mailing address

3333 BURNET AVE., ML 7012
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-6632
  • Fax: 505-272-6620
Mailing address:
  • Phone: 513-636-8444
  • Fax: 513-803-1174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34.012693
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberA-1957-16
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: