Provider Demographics
NPI:1295812444
Name:CAO, DUNG THI PHUONG (MD)
Entity type:Individual
Prefix:DR
First Name:DUNG
Middle Name:THI PHUONG
Last Name:CAO
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:PO BOX 293839
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95829
Mailing Address - Country:US
Mailing Address - Phone:916-428-4118
Mailing Address - Fax:916-428-5460
Practice Address - Street 1:6665 STOCKTON BLVD
Practice Address - Street 2:SUITE 8
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823
Practice Address - Country:US
Practice Address - Phone:916-428-4118
Practice Address - Fax:916-428-5460
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61997208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A619972Medicaid
G48384Medicare UPIN
CA0A619970Medicare ID - Type Unspecified