Provider Demographics
NPI:1598314353
Name:KAO, KATRINA S (DDS)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:S
Last Name:KAO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39271 MISSION BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-3039
Mailing Address - Country:US
Mailing Address - Phone:510-792-7707
Mailing Address - Fax:
Practice Address - Street 1:39271 MISSION BLVD STE 200
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-3039
Practice Address - Country:US
Practice Address - Phone:510-792-7707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104398122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist