Healthcare Provider Details

I. General information

NPI: 1801335542
Provider Name (Legal Business Name): KELLY C. KAO, O.D., A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2017
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 W EL CAMINO REAL STE 6
MOUNTAIN VIEW CA
94040-2462
US

IV. Provider business mailing address

1580 W EL CAMINO REAL STE 6
MOUNTAIN VIEW CA
94040-2462
US

V. Phone/Fax

Practice location:
  • Phone: 650-695-5917
  • Fax:
Mailing address:
  • Phone: 650-695-5917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number13772
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number13772
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number13772
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13772
License Number StateCA

VIII. Authorized Official

Name: KELLY KAO
Title or Position: PRESIDENT
Credential: OD
Phone: 408-396-7179