=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467536755
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENT BIN CAO M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2006
-----------------------------------------------------
Last Update Date | 11/01/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 136-21 ROOSEVELT AVE. SUITE 205
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11354-5507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-353-2536
-----------------------------------------------------
Fax | 718-359-9247
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 136-21 ROOSEVELT AVE. SUITE 205
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11354-5507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-353-2536
-----------------------------------------------------
Fax | 718-359-9247
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 214443
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------