Provider Demographics
NPI:1669879789
Name:ZHONG YI YAO, INC.
Entity type:Organization
Organization Name:ZHONG YI YAO, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:FRANCES
Authorized Official - Last Name:DAVIES
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:949-407-8728
Mailing Address - Street 1:28345 VIA ALFONSE
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-7060
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 S COAST HWY STE 312
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2971
Practice Address - Country:US
Practice Address - Phone:949-407-8728
Practice Address - Fax:949-407-8740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15400261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center