Provider Demographics
NPI:1629295571
Name:KAO, WEI K (MD)
Entity Type:Individual
Prefix:MR
First Name:WEI
Middle Name:K
Last Name:KAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 VETERANS MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-7640
Mailing Address - Country:US
Mailing Address - Phone:631-676-7656
Mailing Address - Fax:631-676-7648
Practice Address - Street 1:3505 VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-7640
Practice Address - Country:US
Practice Address - Phone:631-676-7656
Practice Address - Fax:631-676-7648
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160056207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01018831Medicaid
NYA65064Medicare UPIN
NY01018831Medicaid