Healthcare Provider Details

I. General information

NPI: 1447329693
Provider Name (Legal Business Name): KAITLYN CAO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 E 7TH ST
LONG BEACH CA
90822-5201
US

IV. Provider business mailing address

15200 MAGNOLIA ST APT 103
WESTMINSTER CA
92683-6434
US

V. Phone/Fax

Practice location:
  • Phone: 714-423-4994
  • Fax:
Mailing address:
  • Phone: 714-423-8994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberTCH 72042
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: