Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | DS035020 | PA |
N | 213EG0000X | General Practice | DS035020 | PA |
Y | 1223P0221X | Pediatric Dentist | DS035020 | PA |
NPI | 1104096247 |
---|---|
Provider Name | Shurong Cao |
First Address | Philadelphia, PA 19139-3114 |
Second Address | Philadelphia, PA 19139-3114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2008 |
Last Update Date | 05/03/2008 |