Healthcare Provider Details

I. General information

NPI: 1790150910
Provider Name (Legal Business Name): DONG CAO L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2015
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 COBIA DR STE 1104
KATY TX
77494-7159
US

IV. Provider business mailing address

20811 FIGURINE CT
KATY TX
77450-7070
US

V. Phone/Fax

Practice location:
  • Phone: 832-866-2501
  • Fax:
Mailing address:
  • Phone: 832-866-2501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC01618
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: