Healthcare Provider Details

I. General information

NPI: 1619110590
Provider Name (Legal Business Name): ANNIE YAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 07/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST # 124
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

4301 SATTERWYTHE LN
CHARLOTTE NC
28215-8511
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-2941
  • Fax:
Mailing address:
  • Phone: 310-561-3090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number270503
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: