MEDICARE: HENRY CAO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1609302975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENRY CAO

Provider Business Mailing Address
First Line	:	2001 BEVERLY BLVD
Second Line	:	SUITE 201
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-2403
Country	:	US
Telephone Number	:	213-413-1622
Fax Number	:	213-413-5456

Provider Business Practice Location Address
First Line	:	2001 BEVERLY BLVD
Second Line	:	SUITE 201
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-2403
Country	:	US
Telephone Number	:	213-413-1622
Fax Number	:	213-413-5456

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2017
Last Update Date	:	05/05/2017

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Directions to “ HENRY CAO ” Practice Location

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