Provider Demographics
NPI:1497226625
Name:CAO, PHUONG TUYET
Entity Type:Individual
Prefix:
First Name:PHUONG
Middle Name:TUYET
Last Name:CAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PHUONG
Other - Middle Name:
Other - Last Name:NGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8080 STATE HIGHWAY 121 STE 120
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-2902
Mailing Address - Country:US
Mailing Address - Phone:972-439-3753
Mailing Address - Fax:972-439-3754
Practice Address - Street 1:7668 ELDORADO PKWY STE 200
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-5753
Practice Address - Country:US
Practice Address - Phone:972-439-3753
Practice Address - Fax:972-439-3754
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12833363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant