Healthcare Provider Details

I. General information

NPI: 1689832636
Provider Name (Legal Business Name): JAMES KAO OPHTHALMOLOGY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 E COLORADO BLVD STE 100
PASADENA CA
91101-2178
US

IV. Provider business mailing address

6 CRANE
IRVINE CA
92602-2417
US

V. Phone/Fax

Practice location:
  • Phone: 310-407-5440
  • Fax: 310-407-5441
Mailing address:
  • Phone: 626-890-1899
  • Fax: 949-502-5522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number20A7960
License Number StateCA

VIII. Authorized Official

Name: JAMES KAO
Title or Position: OWNER
Credential: DO, MD, MPH
Phone: 626-890-1899