Healthcare Provider Details

I. General information

NPI: 1942799218
Provider Name (Legal Business Name): KARA RYAN YAO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2018
Last Update Date: 03/04/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD
PHILADELPHIA PA
19104-4319
US

IV. Provider business mailing address

216 S 3RD ST
PHILADELPHIA PA
19106-3802
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-4557
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberMD478520
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: