Provider Demographics
NPI:1437307139
Name:CUONG S. CAO LLC
Entity Type:Organization
Organization Name:CUONG S. CAO LLC
Other - Org Name:MEDICAL REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CUONG
Authorized Official - Middle Name:S
Authorized Official - Last Name:CAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-792-7031
Mailing Address - Street 1:9780 WALNUT ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-2389
Mailing Address - Country:US
Mailing Address - Phone:972-792-7031
Mailing Address - Fax:972-792-7037
Practice Address - Street 1:9780 WALNUT ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-2389
Practice Address - Country:US
Practice Address - Phone:972-792-7031
Practice Address - Fax:972-792-7037
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CUONG S.CAO LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-05
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF007607111N00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty