Provider Demographics
NPI:1366014839
Name:KAO, ANTHONY (NP-C)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:KAO
Suffix:
Gender:M
Credentials:NP-C
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 641519
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-6519
Mailing Address - Country:US
Mailing Address - Phone:310-270-6181
Mailing Address - Fax:833-379-6863
Practice Address - Street 1:1250 S BEVERLY GLEN BLVD APT 202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-5221
Practice Address - Country:US
Practice Address - Phone:310-270-6181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017679363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily