Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 036.094795 | IL |
NPI | 1003160243 |
---|---|
Provider Name | Grace Ann Kao |
First Address | Lindenhurst, IL 60046-9041 |
Second Address | Lindenhurst, IL 60046-9041 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2012 |
Last Update Date | 08/11/2012 |