Healthcare Provider Details

I. General information

NPI: 1861175325
Provider Name (Legal Business Name): KASSIE KAO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 YORBA LINDA BLVD
FULLERTON CA
92831-1615
US

IV. Provider business mailing address

18851 LEESBURY WAY
ROWLAND HEIGHTS CA
91748-4885
US

V. Phone/Fax

Practice location:
  • Phone: 714-449-7400
  • Fax:
Mailing address:
  • Phone: 626-715-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: