Healthcare Provider Details

I. General information

NPI: 1689441776
Provider Name (Legal Business Name): XI CAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2023
Last Update Date: 12/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 CAMPUS POINT DR # MC7723
LA JOLLA CA
92037-1300
US

IV. Provider business mailing address

9300 CAMPUS POINT DR # MC7723
LA JOLLA CA
92037-1300
US

V. Phone/Fax

Practice location:
  • Phone: 858-657-6772
  • Fax: 858-657-5495
Mailing address:
  • Phone: 858-657-6772
  • Fax: 858-657-5495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberPTL13242
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: