Healthcare Provider Details

I. General information

NPI: 1548320500
Provider Name (Legal Business Name): LARRY VINH CAO D.D.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6045 HAZEL AVE SUITE 3
ORANGEVALE CA
95662-4538
US

IV. Provider business mailing address

6045 HAZEL AVE SUITE 3
ORANGEVALE CA
95662-4538
US

V. Phone/Fax

Practice location:
  • Phone: 916-988-0187
  • Fax:
Mailing address:
  • Phone: 916-988-0187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number48240
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: