MEDICARE: EAST LOS ANGELES ENT MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	A83484	CA

General Provider Information

NPI Number	:	1386750198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST LOS ANGELES ENT MEDICAL CENTER

Provider Business Mailing Address
First Line	:	533 W LAS TUNAS DR # 202
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-1133
Country	:	US
Telephone Number	:	626-284-2000
Fax Number	:	626-284-4300

Provider Business Practice Location Address
First Line	:	533 W LAS TUNAS DR # 202
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-1133
Country	:	US
Telephone Number	:	626-284-2000
Fax Number	:	626-284-4300

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SHOUNAN YAO
Credential	:	M.D.
Telephone Number	:	626-284-2000

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	10/14/2025

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