Healthcare Provider Details

I. General information

NPI: 1053696120
Provider Name (Legal Business Name): KHANH-VAN L CAO PHARM.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2011
Last Update Date: 09/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1993 MCKEE RD
SAN JOSE CA
95116-1406
US

IV. Provider business mailing address

PO BOX 32312
SAN JOSE CA
95152-2312
US

V. Phone/Fax

Practice location:
  • Phone: 408-254-6392
  • Fax: 408-254-6469
Mailing address:
  • Phone: 408-254-6392
  • Fax: 408-254-6469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number58881
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: