Healthcare Provider Details

I. General information

NPI: 1689107369
Provider Name (Legal Business Name): ANGELA TRUC DAN CAO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2017
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 E CHESTNUT ST # LEVEL6
LOUISVILLE KY
40202-1713
US

IV. Provider business mailing address

PO BOX 776879
CHICAGO IL
60677-6879
US

V. Phone/Fax

Practice location:
  • Phone: 502-588-9587
  • Fax: 502-588-9580
Mailing address:
  • Phone: 502-559-9529
  • Fax: 502-272-5339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberTP334
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: