=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225641293
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RICHARD T. KAO, DDS, PHD - DENTAL CORP.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2020
-----------------------------------------------------
Last Update Date | 08/28/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1660 WILLOW ST STE 3
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95125-5101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-269-1060
-----------------------------------------------------
Fax | 408-516-8994
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5822 NEWGATE CT
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95138-2379
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-489-6395
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | RICHARD T. KAO
-----------------------------------------------------
Credential | DDS, PHD
-----------------------------------------------------
Telephone | 408-489-6395
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0300X
-----------------------------------------------------
Taxonomy Name | Periodontics
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------