Healthcare Provider Details

I. General information

NPI: 1154730208
Provider Name (Legal Business Name): UYEN CAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2014
Last Update Date: 08/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3943 GRAND AVE
CHINO CA
91710-5440
US

IV. Provider business mailing address

3943 GRAND AVE
CHINO CA
91710-5440
US

V. Phone/Fax

Practice location:
  • Phone: 909-590-7597
  • Fax: 909-590-9692
Mailing address:
  • Phone: 909-590-7597
  • Fax: 909-590-9692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number62938
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: