Provider Demographics
NPI:1114916434
Name:MAO, YVONNE (MD)
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:MAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:255 E ORANGE GROVE AVE
Mailing Address - Street 2:STE D
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1240
Mailing Address - Country:US
Mailing Address - Phone:818-848-5595
Mailing Address - Fax:818-848-5749
Practice Address - Street 1:255 E ORANGE GROVE AVE
Practice Address - Street 2:STE D
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1240
Practice Address - Country:US
Practice Address - Phone:818-848-5595
Practice Address - Fax:818-848-5749
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA73790207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A73790OtherCA LIC
CAGR0069980Medicaid
CAGR0069980Medicaid
CABM7896624OtherDEA
A73790OtherCA LIC