Provider Demographics
NPI:1639141476
Name:KAO, JOHNNY (MD)
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:
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:PO BOX 5934
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-5934
Mailing Address - Country:US
Mailing Address - Phone:516-338-5300
Mailing Address - Fax:516-333-1075
Practice Address - Street 1:1000 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4927
Practice Address - Country:US
Practice Address - Phone:631-376-4047
Practice Address - Fax:631-376-3392
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2347552085R0001X
FLME 1083162085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02678182Medicaid
FL149Y4OtherBCBS
FL002790900Medicaid
FLDR512YMedicare PIN
FL002790900Medicaid
I36659Medicare UPIN