Provider Demographics
NPI:1528170503
Name:KAO, DEAN (PA-C)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:KAO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 SW RANGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:WALDPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97394-3035
Mailing Address - Country:US
Mailing Address - Phone:541-563-3197
Mailing Address - Fax:541-563-6027
Practice Address - Street 1:920 SW RANGE DRIVE
Practice Address - Street 2:
Practice Address - City:WALDPORT
Practice Address - State:OR
Practice Address - Zip Code:97394-3035
Practice Address - Country:US
Practice Address - Phone:541-563-3197
Practice Address - Fax:541-563-6027
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003541363AM0700X
ORPA01051363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical