Provider Demographics
NPI:1558360966
Name:CAO, SEAN (MD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:CAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:THANH-SON
Other - Middle Name:
Other - Last Name:CAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9940 TALBERT AVE
Mailing Address - Street 2:STE. 202
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5153
Mailing Address - Country:US
Mailing Address - Phone:714-378-5790
Mailing Address - Fax:714-378-5544
Practice Address - Street 1:9940 TALBERT AVE
Practice Address - Street 2:STE. 202
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-5153
Practice Address - Country:US
Practice Address - Phone:714-378-5790
Practice Address - Fax:714-378-5544
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73196208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G731960Medicaid
WG73196BMedicare ID - Type Unspecified
CA00G731960Medicaid