Healthcare Provider Details

I. General information

NPI: 1447368402
Provider Name (Legal Business Name): GARY C KAO MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 12/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12900A GARDEN GROVE BLVD #122
GARDEN GROVE CA
92843
US

IV. Provider business mailing address

PO BOX 775
GARDEN GROVE CA
92842
US

V. Phone/Fax

Practice location:
  • Phone: 714-636-0342
  • Fax: 714-636-0391
Mailing address:
  • Phone: 714-636-0342
  • Fax: 714-636-0391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA53740
License Number StateCA

VIII. Authorized Official

Name: GARY C KAO
Title or Position: PRESIDENT
Credential: MD
Phone: 714-636-0342