Provider Demographics
NPI:1720315443
Name:CAO, WEIRAN (NP)
Entity Type:Individual
Prefix:
First Name:WEIRAN
Middle Name:
Last Name:CAO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 HANOVER RD
Mailing Address - Street 2:#201
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91748-1796
Mailing Address - Country:US
Mailing Address - Phone:626-965-4628
Mailing Address - Fax:
Practice Address - Street 1:1661 HANOVER RD
Practice Address - Street 2:#201
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91748-1796
Practice Address - Country:US
Practice Address - Phone:626-965-4628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18066363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA18066OtherN.P