Healthcare Provider Details

I. General information

NPI: 1417563305
Provider Name (Legal Business Name): KEWEI CAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2020
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2568 LOG MILL CT
CROFTON MD
21114-1861
US

IV. Provider business mailing address

2568 LOG MILL CT
CROFTON MD
21114-1861
US

V. Phone/Fax

Practice location:
  • Phone: 202-290-8535
  • Fax:
Mailing address:
  • Phone: 202-290-8535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU02766
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: