Healthcare Provider Details

I. General information

NPI: 1336052794
Provider Name (Legal Business Name): CINDY BAO-NGAN CAO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 HARBOR BLVD STE B230
COSTA MESA CA
92627-5874
US

IV. Provider business mailing address

10402 CIRCULO DE JUAREZ
FOUNTAIN VALLEY CA
92708-3752
US

V. Phone/Fax

Practice location:
  • Phone: 949-646-1650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113872
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: