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General NPI Number Information
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NPI Number | 1639819436
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Entity Type | Individual
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Provider Name | JONICA YU KAO PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/30/2022
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 350 LORTON AVE
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City | BURLINGAME
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State | CA
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Zip | 94010-4104
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Country | US
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Telephone | 360-719-9798
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Fax |
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Provider Business Mailing Address
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Address Line | 19311 NE 15TH CIR
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City | CAMAS
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State | WA
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Zip | 98607-7617
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Country | US
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Telephone | 360-719-9798
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 62695
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License Number State | CA
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