Healthcare Provider Details

I. General information

NPI: 1467536755
Provider Name (Legal Business Name): KENT BIN CAO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136-21 ROOSEVELT AVE. SUITE 205
FLUSHING NY
11354-5507
US

IV. Provider business mailing address

136-21 ROOSEVELT AVE. SUITE 205
FLUSHING NY
11354-5507
US

V. Phone/Fax

Practice location:
  • Phone: 718-353-2536
  • Fax: 718-359-9247
Mailing address:
  • Phone: 718-353-2536
  • Fax: 718-359-9247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number214443
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: