Healthcare Provider Details

I. General information

NPI: 1235667908
Provider Name (Legal Business Name): YEN THI KIM HONG CAO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2017
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 NW MYHRE RD
SILVERDALE WA
98383-7662
US

IV. Provider business mailing address

1900 NW MYHRE RD
SILVERDALE WA
98383-7662
US

V. Phone/Fax

Practice location:
  • Phone: 564-240-3100
  • Fax: 564-240-3199
Mailing address:
  • Phone: 564-240-3100
  • Fax: 564-240-3199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberMD61435695
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD61435695
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD61435695
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: