Provider Demographics
NPI:1295398394
Name:CAO, THANH VAN (MD)
Entity Type:Individual
Prefix:
First Name:THANH
Middle Name:VAN
Last Name:CAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BANNER GATEWAY/ATTN BMG HOSPITALISTS
Mailing Address - Street 2:1900 N HIGLEY DR
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234
Mailing Address - Country:US
Mailing Address - Phone:480-412-6788
Mailing Address - Fax:480-412-6848
Practice Address - Street 1:BANNER GATEWAY/ATTN BMG HOSPITALISTS
Practice Address - Street 2:1900 N HIGLEY DR
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234
Practice Address - Country:US
Practice Address - Phone:480-412-6788
Practice Address - Fax:480-412-6848
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ66863207R00000X, 208M00000X
AZ390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program