Healthcare Provider Details

I. General information

NPI: 1306307848
Provider Name (Legal Business Name): THUY CAO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 10/27/2020
Certification Date: 10/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 N PACIFIC COAST HWY STE 2175
EL SEGUNDO CA
90245-5639
US

IV. Provider business mailing address

2618 W 43RD AVE APT 1
KANSAS CITY KS
66103-3145
US

V. Phone/Fax

Practice location:
  • Phone: 877-878-3289
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2020029554
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: