Healthcare Provider Details

I. General information

NPI: 1093330102
Provider Name (Legal Business Name): KEVIN CAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 06/29/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 CAMBRIDGE ST STE 711
HOUSTON TX
77030-4202
US

IV. Provider business mailing address

7200 CAMBRIDGE ST STE 711
HOUSTON TX
77030-4202
US

V. Phone/Fax

Practice location:
  • Phone: 713-798-6295
  • Fax:
Mailing address:
  • Phone: 713-798-6295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT221537
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: