Healthcare Provider Details

I. General information

NPI: 1083012736
Provider Name (Legal Business Name): RUEY CHYR KAO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2014
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 OAK VIEW AVE
SAN MARINO CA
91108-1114
US

IV. Provider business mailing address

1321 OAK VIEW AVE
SAN MARINO CA
91108-1114
US

V. Phone/Fax

Practice location:
  • Phone: 626-622-0996
  • Fax:
Mailing address:
  • Phone: 626-622-0996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA30704
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: