Healthcare Provider Details

I. General information

NPI: 1598469363
Provider Name (Legal Business Name): AUSTIN C. CAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST
PHILADELPHIA PA
19104-4238
US

IV. Provider business mailing address

729 S 22ND ST APT 2
PHILADELPHIA PA
19146-1782
US

V. Phone/Fax

Practice location:
  • Phone: 414-308-9742
  • Fax:
Mailing address:
  • Phone: 414-308-9742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: