Healthcare Provider Details

I. General information

NPI: 1114635380
Provider Name (Legal Business Name): YINGJIE CAO RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4484 SW SHEM TER
BEAVERTON OR
97078-2193
US

IV. Provider business mailing address

9155 SW BARNES RD STE 987
PORTLAND OR
97225-6625
US

V. Phone/Fax

Practice location:
  • Phone: 206-972-0433
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number10215987
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: