Healthcare Provider Details

I. General information

NPI: 1639100555
Provider Name (Legal Business Name): UYEN-THI THI CAO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 GASTON AVE #550
DALLAS TX
75246-1904
US

IV. Provider business mailing address

PO BOX 849931
DALLAS TX
75284-0001
US

V. Phone/Fax

Practice location:
  • Phone: 214-821-1177
  • Fax: 214-821-1193
Mailing address:
  • Phone: 214-821-1177
  • Fax: 214-821-1193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberL6310
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: