Healthcare Provider Details

I. General information

NPI: 1134680929
Provider Name (Legal Business Name): YISHENG CAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 06/15/2025
Certification Date: 06/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2405 ATHERHOLT RD
LYNCHBURG VA
24501-2184
US

IV. Provider business mailing address

100 MEREDITH PL
LYNCHBURG VA
24503-2127
US

V. Phone/Fax

Practice location:
  • Phone: 434-363-4133
  • Fax:
Mailing address:
  • Phone: 917-821-6099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number0101282969
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number1134680929
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: