Healthcare Provider Details

I. General information

NPI: 1316385057
Provider Name (Legal Business Name): KHANH HUU HONG CAO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 STANTONSBURG RD
GREENVILLE NC
27834
US

IV. Provider business mailing address

1800 HARRISON ST, 7TH FL
OAKLAND CA
94612-3429
US

V. Phone/Fax

Practice location:
  • Phone: 252-744-4184
  • Fax: 252-744-4125
Mailing address:
  • Phone: 510-625-4101
  • Fax: 877-738-4262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA142171
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: