MEDICARE: DR. TONY T KAO DDS

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	1223G0001X	General Practice Dentistry	49118	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D49118	OTHER	CA	DENTICAL PROVIDER NUMBER

General Provider Information

NPI Number	:	1619186996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TONY T KAO DDS

Provider Business Mailing Address
First Line	:	2287 LERONA AVE
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-3914
Country	:	US
Telephone Number	:	626-964-7893
Fax Number	:

Provider Business Practice Location Address
First Line	:	18750 COLIMA RD STE A1
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-2962
Country	:	US
Telephone Number	:	622-965-2521
Fax Number	:

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/08/2007

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