Healthcare Provider Details

I. General information

NPI: 1134624638
Provider Name (Legal Business Name): DIEM CAO DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 05/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8813 ALONDRA BLVD
PARAMOUNT CA
90723-4603
US

IV. Provider business mailing address

8813 ALONDRA BLVD
PARAMOUNT CA
90723-4603
US

V. Phone/Fax

Practice location:
  • Phone: 818-383-5350
  • Fax:
Mailing address:
  • Phone: 818-383-5350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDDS101136
License Number StateCA

VIII. Authorized Official

Name: DR. DIEM CAO
Title or Position: DENTIST
Credential: DDS
Phone: 818-383-5350