MEDICARE: JACK SHIH-CHIEH KAO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	219901	MA
2	207R00000X	Internal Medicine Physician	A69438	CA
3	207L00000X	Anesthesiology Physician	A69438	CA

General Provider Information

NPI Number	:	1013960475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACK SHIH-CHIEH KAO M.D.

Provider Business Mailing Address
First Line	:	1155 S GRAND AVE APT 1212
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-2789
Country	:	US
Telephone Number	:	714-309-6697
Fax Number	:

Provider Business Practice Location Address
First Line	:	1155 S GRAND AVE APT 1212
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-2789
Country	:	US
Telephone Number	:	714-309-6697
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	03/02/2015

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