MEDICARE: DR. WYNN HUGH KAO M.D., PH.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	207N00000X	Dermatology Physician	036.143480	IL

General Provider Information

NPI Number	:	1790996890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WYNN HUGH KAO M.D., PH.D.

Provider Business Mailing Address
First Line	:	3024 E EMPIRE ST STE E&F
Second Line	:
City	:	BLOOMINGTON
State	:	IL
Zip	:	61704-5402
Country	:	US
Telephone Number	:	309-451-3376
Fax Number	:	309-452-3376

Provider Business Practice Location Address
First Line	:	3024 E EMPIRE ST
Second Line	:	STE E & F
City	:	BLOOMINGTON
State	:	IL
Zip	:	61704-5402
Country	:	US
Telephone Number	:	309-451-3376
Fax Number	:	309-452-3376

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	07/21/2022

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