Healthcare Provider Details

I. General information

NPI: 1528170503
Provider Name (Legal Business Name): DEAN KAO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 SW RANGE DRIVE
WALDPORT OR
97394-3035
US

IV. Provider business mailing address

920 SW RANGE DRIVE
WALDPORT OR
97394-3035
US

V. Phone/Fax

Practice location:
  • Phone: 541-563-3197
  • Fax: 541-563-6027
Mailing address:
  • Phone: 541-563-3197
  • Fax: 541-563-6027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA10003541
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA01051
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: