Healthcare Provider Details

I. General information

NPI: 1295812444
Provider Name (Legal Business Name): DUNG THI PHUONG CAO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6665 STOCKTON BLVD SUITE 8
SACRAMENTO CA
95823
US

IV. Provider business mailing address

PO BOX 293839
SACRAMENTO CA
95829
US

V. Phone/Fax

Practice location:
  • Phone: 916-428-4118
  • Fax: 916-428-5460
Mailing address:
  • Phone: 916-428-4118
  • Fax: 916-428-5460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA61997
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: