Provider Demographics
NPI:1003160243
Name:KAO, GRACE ANN (MD)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:ANN
Last Name:KAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:ANN
Other - Last Name:KUO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2031 E GRAND AVE
Mailing Address - Street 2:#200
Mailing Address - City:LINDENHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60046-9041
Mailing Address - Country:US
Mailing Address - Phone:847-356-5575
Mailing Address - Fax:847-356-1792
Practice Address - Street 1:2031 E GRAND AVE
Practice Address - Street 2:#200
Practice Address - City:LINDENHURST
Practice Address - State:IL
Practice Address - Zip Code:60046-9041
Practice Address - Country:US
Practice Address - Phone:847-356-5575
Practice Address - Fax:847-356-1792
Is Sole Proprietor?:No
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.094795208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics