Healthcare Provider Details

I. General information

NPI: 1689555492
Provider Name (Legal Business Name): JENNIFER CAO LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 PARKMOOR AVE
SAN JOSE CA
95128-2407
US

IV. Provider business mailing address

1555 PARKMOOR AVE
SAN JOSE CA
95128-2407
US

V. Phone/Fax

Practice location:
  • Phone: 408-282-0402
  • Fax:
Mailing address:
  • Phone: 408-282-0402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number738706
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: