Healthcare Provider Details

I. General information

NPI: 1922100213
Provider Name (Legal Business Name): SHIMIN CAO M.D. PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3808 UNION ST STE 6B
FLUSHING NY
11354-5672
US

IV. Provider business mailing address

3024 150TH PL
FLUSHING NY
11354-2423
US

V. Phone/Fax

Practice location:
  • Phone: 618-559-6549
  • Fax:
Mailing address:
  • Phone: 618-559-6549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number262917
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: