Healthcare Provider Details

I. General information

NPI: 1194056341
Provider Name (Legal Business Name): JUNHONG CAO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2010
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14220 FRANKLIN AVE
FLUSHING NY
11355-2640
US

IV. Provider business mailing address

4108 PARSONS BLVD APT 2D
FLUSHING NY
11355-1937
US

V. Phone/Fax

Practice location:
  • Phone: 347-542-8226
  • Fax:
Mailing address:
  • Phone: 626-243-3419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number018386-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: