Provider Demographics
NPI:1225385297
Name:CAO, JASON THAI
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:THAI
Last Name:CAO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9211 BOLSA AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5570
Mailing Address - Country:US
Mailing Address - Phone:714-893-1010
Mailing Address - Fax:
Practice Address - Street 1:9211 BOLSA AVE STE 210
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5570
Practice Address - Country:US
Practice Address - Phone:714-893-1010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA617121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice