Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DN25665 | FL |
NPI | 1073053971 |
---|---|
Provider Name | Kristy Kao |
First Address | Fort Lauderdale, FL 33301-4328 |
Second Address | Wilton Manors, FL 33305-1430 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2017 |
Last Update Date | 06/05/2021 |