Provider Demographics
NPI:1548419302
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:
Authorized Official - First Name:CUONG
Authorized Official - Middle Name:S
Authorized Official - Last Name:CAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-494-0500
Mailing Address - Street 1:PO BOX 744006
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75374-4006
Mailing Address - Country:US
Mailing Address - Phone:972-494-0500
Mailing Address - Fax:972-494-0501
Practice Address - Street 1:3901 W WALNUT ST
Practice Address - Street 2:SUITE B
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-6220
Practice Address - Country:US
Practice Address - Phone:972-494-0500
Practice Address - Fax:972-494-0501
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CUONG S.CAO LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-16
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A0119Medicare PIN