Provider Demographics
NPI:1891968384
Name:KAO, AMY WAN-JU (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:WAN-JU
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 1:1001 SNEATH LN STE 310
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-2349
Mailing Address - Country:US
Mailing Address - Phone:650-615-6051
Mailing Address - Fax:650-615-6066
Practice Address - Street 1:1001 SNEATH LN STE 310
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-2349
Practice Address - Country:US
Practice Address - Phone:650-615-6051
Practice Address - Fax:650-615-6066
Is Sole Proprietor?:No
Enumeration Date:2008-04-07
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1123762085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology