1205871233 NPI number — SHIH YIN ANNA KAO M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205871233 NPI number — SHIH YIN ANNA KAO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAO
Provider First Name:
SHIH YIN
Provider Middle Name:
ANNA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KAO
Provider Other First Name:
SHIH YIN
Provider Other Middle Name:
ANNA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1205871233
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CLARK-HOLDER CLINIC, P.A.
Provider Second Line Business Mailing Address:
303 SMITH STREET
Provider Business Mailing Address City Name:
LAGRANGE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-882-8831
Provider Business Mailing Address Fax Number:
706-812-4091

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CLARK-HOLDER CLINIC, P.A.
Provider Second Line Business Practice Location Address:
303 SMITH STREET
Provider Business Practice Location Address City Name:
LAGRANGE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-882-8831
Provider Business Practice Location Address Fax Number:
706-812-4091
Provider Enumeration Date:
06/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  48788 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 009932400 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000876158A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com