Healthcare Provider Details

I. General information

NPI: 1518691328
Provider Name (Legal Business Name): YIYAN CAO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2022
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4509 TALBOT RD S STE 102
RENTON WA
98055-6294
US

IV. Provider business mailing address

22727 HIGHWAY 99 STE 205
EDMONDS WA
98026-8381
US

V. Phone/Fax

Practice location:
  • Phone: 425-480-9961
  • Fax:
Mailing address:
  • Phone: 425-480-9961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA61098976
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: