Healthcare Provider Details

I. General information

NPI: 1265639728
Provider Name (Legal Business Name): LEON KAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 09/05/2022
Certification Date: 09/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19851 OBSERVATION DR STE 375
GERMANTOWN MD
20876-4151
US

IV. Provider business mailing address

19851 OBSERVATION DR STE 375
GERMANTOWN MD
20876-4151
US

V. Phone/Fax

Practice location:
  • Phone: 301-972-3709
  • Fax: 301-515-3612
Mailing address:
  • Phone: 301-972-3709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberD0074337
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: