Healthcare Provider Details

I. General information

NPI: 1104344233
Provider Name (Legal Business Name): QI CAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S BUENA VISTA ST
BURBANK CA
91505-4809
US

IV. Provider business mailing address

400 S BURNSIDE AVE APT 3D
LOS ANGELES CA
90036-5442
US

V. Phone/Fax

Practice location:
  • Phone: 818-847-6022
  • Fax: 818-847-6029
Mailing address:
  • Phone: 424-270-4897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA166100
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: