Provider Demographics
NPI:1629144464
Name:JAO, KEDY YING (DO)
Entity Type:Individual
Prefix:DR
First Name:KEDY
Middle Name:YING
Last Name:JAO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:KEDY
Other - Middle Name:YING
Other - Last Name:JAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:500 S KRAEMER BLVD
Mailing Address - Street 2:#240
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-6728
Mailing Address - Country:US
Mailing Address - Phone:714-930-1351
Mailing Address - Fax:714-930-1361
Practice Address - Street 1:500 S KRAEMER BLVD
Practice Address - Street 2:#240
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-6728
Practice Address - Country:US
Practice Address - Phone:714-930-1351
Practice Address - Fax:714-930-1361
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4947207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17347Medicare PIN