Healthcare Provider Details

I. General information

NPI: 1841631504
Provider Name (Legal Business Name): CHRISTINE JANE CAO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2013
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 164TH ST SW STE H
LYNNWOOD WA
98087-8193
US

IV. Provider business mailing address

1704 S VEGA ST
ALHAMBRA CA
91801-5633
US

V. Phone/Fax

Practice location:
  • Phone: 425-787-2402
  • Fax:
Mailing address:
  • Phone: 626-400-9471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE60581079
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: