MEDICARE: DR. MARY REI-CHI TAO 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	208000000X	Pediatrics	A70229	CA

General Provider Information

NPI Number	:	1710054036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY REI-CHI TAO M.D.

Provider Business Mailing Address
First Line	:	615 WEST RD
Second Line	:
City	:	LA HABRA HEIGHTS
State	:	CA
Zip	:	90631-8077
Country	:	US
Telephone Number	:	562-694-6106
Fax Number	:	562-694-6109

Provider Business Practice Location Address
First Line	:	331 THE CITY DR S
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92868-3205
Country	:	US
Telephone Number	:	714-567-7387
Fax Number	:

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

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	07/08/2007

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