Healthcare Provider Details

I. General information

NPI: 1619420023
Provider Name (Legal Business Name): CHIH-YUN TAO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6333 LONG AVE STE 201
SHAWNEE KS
66216-2544
US

IV. Provider business mailing address

6333 LONG AVE STE 201
SHAWNEE KS
66216-2544
US

V. Phone/Fax

Practice location:
  • Phone: 913-268-9300
  • Fax:
Mailing address:
  • Phone: 913-268-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2020039834
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number62188
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: