Healthcare Provider Details

I. General information

NPI: 1558360966
Provider Name (Legal Business Name): SEAN CAO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: THANH-SON CAO M.D.

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9940 TALBERT AVE STE. 202
FOUNTAIN VALLEY CA
92708-5153
US

IV. Provider business mailing address

9940 TALBERT AVE STE. 202
FOUNTAIN VALLEY CA
92708-5153
US

V. Phone/Fax

Practice location:
  • Phone: 714-378-5790
  • Fax: 714-378-5544
Mailing address:
  • Phone: 714-378-5790
  • Fax: 714-378-5544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG73196
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: