Healthcare Provider Details

I. General information

NPI: 1952450553
Provider Name (Legal Business Name): VANCE H CAO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 10/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOAG DR MEDICAL STAFF
NEWPORT BEACH CA
92663-4162
US

IV. Provider business mailing address

PO BOX 3589
NEWPORT BEACH CA
92659-8589
US

V. Phone/Fax

Practice location:
  • Phone: 949-764-4624
  • Fax:
Mailing address:
  • Phone: 949-574-5642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA94365
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: