Healthcare Provider Details

I. General information

NPI: 1588548598
Provider Name (Legal Business Name): YIFAN CAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 08/04/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22041 UNION TPKE
OAKLAND GARDENS NY
11364-3542
US

IV. Provider business mailing address

9 HOMESTEAD PL APT 2313
JERSEY CITY NJ
07306-2888
US

V. Phone/Fax

Practice location:
  • Phone: 347-790-8386
  • Fax:
Mailing address:
  • Phone: 612-203-5752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: