Healthcare Provider Details

I. General information

NPI: 1922662055
Provider Name (Legal Business Name): TCHIDO YAO NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2019
Last Update Date: 07/26/2022
Certification Date: 01/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 CENTRAL AVE S STE 203
KENT WA
98032-7430
US

IV. Provider business mailing address

1314 CENTRAL AVE S STE 203
KENT WA
98032-7430
US

V. Phone/Fax

Practice location:
  • Phone: 888-867-0204
  • Fax: 888-867-2165
Mailing address:
  • Phone: 888-867-0204
  • Fax: 888-867-2165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN60730407
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61186350
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: