Basic Information
| Provider Information | |||||||||
| NPI: | 1235286113 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YAO | ||||||||
| FirstName: | TOM | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 E GRAY ST STE 1105 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402023907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025831697 | ||||||||
| FaxNumber: | 5025832120 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2007 | ||||||||
| LastUpdateDate: | 01/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 42683 | KY | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 105275 | 01 | KY | SIHO - NNIKY | OTHER | 50024755 | 01 | KY | PASSPORT - NNIKY | OTHER | 7100074160 | 01 | KY | MEDICAID - KY - NNIKY | OTHER | 000000621167 | 01 | KY | ANTHEM - NNIKY | OTHER | 00533143 | 01 | KY | MEDICARE KY - NNIKY | OTHER | 000023036T | 01 | KY | HUMANA - NNIKY | OTHER | 200967290 | 05 | IN | MEDICAID | 3725189000 | 01 | KY | PASSPORT ADVTG - NNIKY | OTHER |