Provider Demographics
NPI:1376698233
Name:KAO, EDDIE K (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:K
Last Name:KAO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17502 IRVINE BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3127
Mailing Address - Country:US
Mailing Address - Phone:714-598-1488
Mailing Address - Fax:
Practice Address - Street 1:17502 IRVINE BLVD STE E
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3127
Practice Address - Country:US
Practice Address - Phone:714-598-1488
Practice Address - Fax:626-962-5411
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA567731223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice