Healthcare Provider Details

I. General information

NPI: 1629073762
Provider Name (Legal Business Name): SIU-SUN YAO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 06/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WEST 57TH STREET, SUITE 610
NEW YORK NY
10019
US

IV. Provider business mailing address

200 WEST 57TH STREET, SUITE 610
NEW YORK NY
10019
US

V. Phone/Fax

Practice location:
  • Phone: 212-432-7837
  • Fax: 347-713-7736
Mailing address:
  • Phone: 212-432-7837
  • Fax: 347-713-7736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number195625
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: