Healthcare Provider Details

I. General information

NPI: 1285704304
Provider Name (Legal Business Name): SON CAO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5344 W CYPRESS AVE SUITE 101
VISALIA CA
93277-8339
US

IV. Provider business mailing address

5344 W CYPRESS AVE SUITE 101
VISALIA CA
93277-8339
US

V. Phone/Fax

Practice location:
  • Phone: 559-635-4391
  • Fax: 559-635-4662
Mailing address:
  • Phone: 559-635-4391
  • Fax: 559-635-4662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number45359
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: