Provider Demographics
NPI:1164545042
Name:CAO, JIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JIAN
Middle Name:
Last Name:CAO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3324 W HELLMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-2555
Mailing Address - Country:US
Mailing Address - Phone:626-320-2207
Mailing Address - Fax:
Practice Address - Street 1:3324 W HELLMAN AVE
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-2555
Practice Address - Country:US
Practice Address - Phone:626-320-2207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-07
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54548122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA54548OtherCALIFORNIA LICENSE