Healthcare Provider Details

I. General information

NPI: 1811868011
Provider Name (Legal Business Name): JINGJING CAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2025
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13421 MAPLE AVE
FLUSHING NY
11355-4527
US

IV. Provider business mailing address

4016 158TH ST
FLUSHING NY
11358-1619
US

V. Phone/Fax

Practice location:
  • Phone: 718-886-5253
  • Fax:
Mailing address:
  • Phone: 917-681-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number312474
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: