Provider Demographics
NPI:1205934312
Name:KAO, GRACE (MD)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:KAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:W
Other - Last Name:KAOSU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3766
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90632-3766
Mailing Address - Country:US
Mailing Address - Phone:714-525-4002
Mailing Address - Fax:714-525-4002
Practice Address - Street 1:15785 LAGUNA CANYON RD
Practice Address - Street 2:255
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3165
Practice Address - Country:US
Practice Address - Phone:949-551-8588
Practice Address - Fax:949-336-6205
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA044855207W00000X, 2084N0008X
CAA448552084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF89558Medicare UPIN
CAA44855AMedicare ID - Type Unspecified
CAWA44855AMedicare PIN