1205885894 NPI number — THAI M CAO M.D.

Table of content: THAI M CAO M.D. (NPI 1205885894)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205885894 NPI number — THAI M CAO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAO
Provider First Name:
THAI
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205885894
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1515 N VERMONT AVE FL 8
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90027-5337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-783-8987
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1515 N VERMONT AVE FL 8
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90027-5337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-783-8987
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/09/2006

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: 207R00000X , with the licence number:  5731277-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: 5731277-1205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100502393 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 57312771200001 . This is a "REGENCE BCBS #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 109159018 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 81108 . This is a "PEHP #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 228843 . This is a "ALTIUS #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 58652 . This is a "UNIVERSITY HEALTH PLANS #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 807076700 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0093789 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 03809030 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 107033648101 . This is a "IHC #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 107033648H02 . This is a "IHC HUNTSMAN #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 880872 . This is a "DMBA #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 122181700 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 870442845THC . This is a "EMIA #" identifier . This identifiers is of the category "OTHER".
  • Identifier: D5923 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




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