Provider Demographics
NPI:1467536755
Name:CAO, KENT BIN (MD)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:BIN
Last Name:CAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:136-21 ROOSEVELT AVE.
Mailing Address - Street 2:SUITE 205
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5507
Mailing Address - Country:US
Mailing Address - Phone:718-353-2536
Mailing Address - Fax:718-359-9247
Practice Address - Street 1:136-21 ROOSEVELT AVE.
Practice Address - Street 2:SUITE 205
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5507
Practice Address - Country:US
Practice Address - Phone:718-353-2536
Practice Address - Fax:718-359-9247
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY214443207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY214443OtherHIP
NY835281OtherEMPIRE BC/BS
NYP2004133OtherOXFORD
NY2596859OtherGHI
NY02009103Medicaid
NY03626Medicare ID - Type Unspecified
NY02009103Medicaid
NY03789GMedicare ID - Type Unspecified