Provider Demographics
NPI:1275810251
Name:EDDIE K. KAO DDS INC.
Entity Type:Organization
Organization Name:EDDIE K. KAO DDS INC.
Other - Org Name:EDDIE KAO DDS FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-962-5415
Mailing Address - Street 1:933 S SUNSET AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:933 S SUNSET AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3410
Practice Address - Country:US
Practice Address - Phone:626-962-5415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56773261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental