Provider Demographics
NPI:1922100213
Name:CAO, SHIMIN (MD PHD)
Entity Type:Individual
Prefix:
First Name:SHIMIN
Middle Name:
Last Name:CAO
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 150TH PL
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-2423
Mailing Address - Country:US
Mailing Address - Phone:618-559-6549
Mailing Address - Fax:
Practice Address - Street 1:3808 UNION ST STE 6B
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5672
Practice Address - Country:US
Practice Address - Phone:618-559-6549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY262917207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03517851Medicaid