MEDICARE: YUJUN LAO

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP10487	AZ
2	363LP2300X	Primary Care Nurse Practitioner	AP10487	AZ
3	363LF0000X	Family Nurse Practitioner	AP10487	AZ

General Provider Information

NPI Number	:	1437679701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YUJUN LAO

Provider Business Mailing Address
First Line	:	3130 N ARIZONA AVE STE 101
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85225-7162
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6709 E SOUTHERN AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85206-3738
Country	:	US
Telephone Number	:	480-773-2220
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2017
Last Update Date	:	04/10/2023

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Directions to “ YUJUN LAO ” Practice Location

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