=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134075716
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YOUBAO SHA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2026
-----------------------------------------------------
Last Update Date | 03/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3647 RONALD CT
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94538-5555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-778-4700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3647 RONALD CT
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94538-5555
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-778-4700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207SG0203X
-----------------------------------------------------
Taxonomy Name | Clinical Molecular Genetics Physician
-----------------------------------------------------
License Number | 2019214
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------