Healthcare Provider Details

I. General information

NPI: 1407558372
Provider Name (Legal Business Name): BOYU CAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10190 CULVER BLVD
CULVER CITY CA
90232-3152
US

IV. Provider business mailing address

3827 GOLDWYN TER
CULVER CITY CA
90232-3103
US

V. Phone/Fax

Practice location:
  • Phone: 310-837-9700
  • Fax:
Mailing address:
  • Phone: 310-748-5526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number303623
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: