Healthcare Provider Details

I. General information

NPI: 1710168687
Provider Name (Legal Business Name): KEDY YING JAO D.O. A MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S KRAEMER BLVD STE 240
BREA CA
92821-6778
US

IV. Provider business mailing address

500 S KRAEMER BLVD STE 240
BREA CA
92821-6778
US

V. Phone/Fax

Practice location:
  • Phone: 714-930-1351
  • Fax: 714-930-1361
Mailing address:
  • Phone: 714-930-1351
  • Fax: 714-930-1361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KEDY YING JAO
Title or Position: D.O.
Credential: D.O.
Phone: 714-930-1351