Provider Demographics
NPI:1417956020
Name:KAO, DAVID MING FUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MING FUNG
Last Name:KAO
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 1:6370 SW BORLAND RD STE 200
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-9752
Mailing Address - Country:US
Mailing Address - Phone:503-691-1122
Mailing Address - Fax:503-691-1144
Practice Address - Street 1:6370 SW BORLAND RD STE 200
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9752
Practice Address - Country:US
Practice Address - Phone:503-691-1122
Practice Address - Fax:503-691-1144
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2022-03-30
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
OR23409174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR287107Medicaid
OR130404Medicare PIN
ORH58822Medicare UPIN