=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376658146
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YUMI ELIZABETH ANDO M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/20/2006
-----------------------------------------------------
Last Update Date | 01/13/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 887 OAK GROVE AVE STE B
-----------------------------------------------------
City | MENLO PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94025-4430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-530-2719
-----------------------------------------------------
Fax | 650-434-0328
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 887 OAK GROVE AVE STE B
-----------------------------------------------------
City | MENLO PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94025-4430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-530-2719
-----------------------------------------------------
Fax | 650-434-0328
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | A63006
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------