Healthcare Provider Details

I. General information

NPI: 1720221799
Provider Name (Legal Business Name): HAITAO CAO PH.D., LIC.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1707 FORTVIEW RD
AUSTIN TX
78704-7620
US

IV. Provider business mailing address

1707 FORTVIEW RD
AUSTIN TX
78704-7620
US

V. Phone/Fax

Practice location:
  • Phone: 512-707-8828
  • Fax: 512-444-8091
Mailing address:
  • Phone: 512-445-4444
  • Fax: 512-444-8091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC01057
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: