Provider Demographics
NPI:1386934693
Name:YAO, CHENGYIN
Entity type:Individual
Prefix:
First Name:CHENGYIN
Middle Name:
Last Name:YAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 WEST SAGINAW STREET
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48915-1966
Mailing Address - Country:US
Mailing Address - Phone:517-374-6103
Mailing Address - Fax:
Practice Address - Street 1:1019 WEST SAGINAW STREET
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48915-1966
Practice Address - Country:US
Practice Address - Phone:517-374-6103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302035404183500000X
OHRPH.03230751-2183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist