Provider Demographics
NPI:1770502825
Name:CAO, LUYEN VAN (MD)
Entity Type:Individual
Prefix:DR
First Name:LUYEN
Middle Name:VAN
Last Name:CAO
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 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1905 W HEBRON LN STE 206
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-7467
Practice Address - Country:US
Practice Address - Phone:502-957-2084
Practice Address - Fax:502-957-1058
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047877A207R00000X
KY26348207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100384340AMedicaid
KY64263486Medicaid
KYK142440Medicare PIN
891020Medicare ID - Type Unspecified
IN100384340AMedicaid