Provider Demographics
NPI:1295779684
Name:KAO, JONATHAN B (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:B
Last Name:KAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5620 E BROADWAY RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1438
Mailing Address - Country:US
Mailing Address - Phone:480-981-6111
Mailing Address - Fax:480-985-2426
Practice Address - Street 1:5620 E BROADWAY RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1438
Practice Address - Country:US
Practice Address - Phone:480-981-6111
Practice Address - Fax:480-985-2426
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2006007890207W00000X
AZ37351207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
156637Medicare UPIN