Provider Demographics
NPI:1689714248
Name:KAO, JENNIFER CY (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:CY
Last Name:KAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 BLAKE WILBUR DR
Mailing Address - Street 2:#2234
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-2205
Mailing Address - Country:US
Mailing Address - Phone:650-723-8462
Mailing Address - Fax:650-736-7562
Practice Address - Street 1:875 BLAKE WILBUR DR
Practice Address - Street 2:#2234
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-2205
Practice Address - Country:US
Practice Address - Phone:650-723-8462
Practice Address - Fax:650-736-7562
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50265174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G502650Medicaid
CA00G502650Medicaid
CA00G502652Medicare ID - Type UnspecifiedNUMBER