Provider Demographics
NPI:1497468953
Name:CAO, SAMANTHA TU NHI
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:TU NHI
Last Name:CAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2149 DELIA PL
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-2035
Mailing Address - Country:US
Mailing Address - Phone:626-759-4951
Mailing Address - Fax:
Practice Address - Street 1:2149 DELIA PL
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-2035
Practice Address - Country:US
Practice Address - Phone:626-759-4951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant