Provider Demographics
NPI:1790996890
Name:KAO, WYNN HUGH (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:WYNN
Middle Name:HUGH
Last Name:KAO
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3024 E EMPIRE ST STE E&F
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-5402
Mailing Address - Country:US
Mailing Address - Phone:309-451-3376
Mailing Address - Fax:309-452-3376
Practice Address - Street 1:3024 E EMPIRE ST
Practice Address - Street 2:STE E & F
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-5402
Practice Address - Country:US
Practice Address - Phone:309-451-3376
Practice Address - Fax:309-452-3376
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.143480207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology