Healthcare Provider Details

I. General information

NPI: 1629173364
Provider Name (Legal Business Name): HAO KIM CAO D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12116 BEACH BLVD
STANTON CA
90680-3704
US

IV. Provider business mailing address

12116 BEACH BLVD
STANTON CA
90680-3704
US

V. Phone/Fax

Practice location:
  • Phone: 714-898-2222
  • Fax:
Mailing address:
  • Phone: 323-724-0019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A8276
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: