Basic Information
| Provider Information | |||||||||
| NPI: | 1386726602 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAO | ||||||||
| FirstName: | EVA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 WHITE HORSE PIKE | ||||||||
| Address2: | |||||||||
| City: | HADDON HEIGHTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080351294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563100042 | ||||||||
| FaxNumber: | 8563100092 | ||||||||
| Practice Location | |||||||||
| Address1: | 2 WHITE HORSE PIKE | ||||||||
| Address2: | |||||||||
| City: | HADDON HEIGHTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080351294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563100042 | ||||||||
| FaxNumber: | 8563100092 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 26NJ00026700 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 0034754 | 05 | NJ | MEDICAID |