Provider Demographics
NPI:1699292664
Name:TITO GO YAO MD SC
Entity type:Organization
Organization Name:TITO GO YAO MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:TITO
Authorized Official - Middle Name:GO
Authorized Official - Last Name:YAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-287-0751
Mailing Address - Street 1:322 TRINITY LN
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2561
Mailing Address - Country:US
Mailing Address - Phone:773-287-0751
Mailing Address - Fax:630-850-7679
Practice Address - Street 1:5140 W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651-2903
Practice Address - Country:US
Practice Address - Phone:773-287-0751
Practice Address - Fax:773-287-0451
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TITO GO YAO MD SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty