Provider Demographics
NPI:1346221439
Name:KAO, JAYLYNN (MD)
Entity Type:Individual
Prefix:
First Name:JAYLYNN
Middle Name:
Last Name:KAO
Suffix:
Gender:F
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:PO BOX 1648
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-1648
Mailing Address - Country:US
Mailing Address - Phone:541-687-4900
Mailing Address - Fax:541-687-4904
Practice Address - Street 1:1580 VALLEY RIVER DR
Practice Address - Street 2:SUITE 210
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-2116
Practice Address - Country:US
Practice Address - Phone:541-687-4900
Practice Address - Fax:541-687-4904
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD27227208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR272371Medicaid
OR272371Medicaid