Healthcare Provider Details

I. General information

NPI: 1114130507
Provider Name (Legal Business Name): YI CAO L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 YORK ST
DENVER CO
80206-2157
US

IV. Provider business mailing address

21392 E LEHIGH AVE
AURORA CO
80013-9097
US

V. Phone/Fax

Practice location:
  • Phone: 720-289-9946
  • Fax:
Mailing address:
  • Phone: 720-289-9946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number815
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: