Provider Demographics
NPI:1518386119
Name:CAO, DIEU NGOC
Entity Type:Individual
Prefix:
First Name:DIEU
Middle Name:NGOC
Last Name:CAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:NGOC
Other - Last Name:CAO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:#1 KING'S WAY
Mailing Address - Street 2:P.O BOX #8
Mailing Address - City:AVENAL
Mailing Address - State:CA
Mailing Address - Zip Code:93204-7016
Mailing Address - Country:US
Mailing Address - Phone:559-386-0587
Mailing Address - Fax:559-386-7442
Practice Address - Street 1:1 KINGS WAY
Practice Address - Street 2:
Practice Address - City:AVENAL
Practice Address - State:CA
Practice Address - Zip Code:93204-9708
Practice Address - Country:US
Practice Address - Phone:559-386-0587
Practice Address - Fax:559-386-7442
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46745183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist