Provider Demographics
NPI:1790840858
Name:KAO, JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
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 1:900 LAFAYETTE ST STE 105
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-4966
Mailing Address - Country:US
Mailing Address - Phone:408-293-7767
Mailing Address - Fax:408-294-6595
Practice Address - Street 1:900 LAFAYETTE ST STE 105
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-4966
Practice Address - Country:US
Practice Address - Phone:408-293-7767
Practice Address - Fax:408-294-6595
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64661207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF41941Medicare UPIN
CA00G64661Medicare ID - Type Unspecified