Provider Demographics
NPI:1053696120
Name:CAO, KHANH-VAN L (PHARMD)
Entity type:Individual
Prefix:
First Name:KHANH-VAN
Middle Name:L
Last Name:CAO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32312
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95152-2312
Mailing Address - Country:US
Mailing Address - Phone:408-254-6392
Mailing Address - Fax:408-254-6469
Practice Address - Street 1:1993 MCKEE RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1406
Practice Address - Country:US
Practice Address - Phone:408-254-6392
Practice Address - Fax:408-254-6469
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58881183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist