Provider Demographics
NPI:1942258520
Name:KAO, JERRY KUO-CHENG (PT)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:KUO-CHENG
Last Name:KAO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:KUO-CHENG JERRY
Other - Middle Name:
Other - Last Name:KAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3334 ALBEDO ST
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-6101
Mailing Address - Country:US
Mailing Address - Phone:626-330-9396
Mailing Address - Fax:626-330-9396
Practice Address - Street 1:3178 ALLENTON AVE
Practice Address - Street 2:
Practice Address - City:HACIENDA HTS
Practice Address - State:CA
Practice Address - Zip Code:91745-6403
Practice Address - Country:US
Practice Address - Phone:626-330-9396
Practice Address - Fax:626-330-9396
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27568225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist