Provider Demographics
NPI:1629288295
Name:CAO, YOU JUN
Entity Type:Individual
Prefix:
First Name:YOU JUN
Middle Name:
Last Name:CAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13512 ROOSEVELT AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5314
Mailing Address - Country:US
Mailing Address - Phone:718-961-3218
Mailing Address - Fax:718-961-3218
Practice Address - Street 1:135-12 ROOSEVELT AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5314
Practice Address - Country:US
Practice Address - Phone:718-961-3218
Practice Address - Fax:718-961-3218
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2496-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist