Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 59831 | CA |
Y | 213EG0000X | General Practice | 59831 | CA |
NPI | 1003124264 |
---|---|
Provider Name | Dr. Phuong-Thao Thi Dao |
First Address | Gardena, CA 90249-3700 |
Second Address | Paramount, CA 90723-4377 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2010 |
Last Update Date | 01/09/2016 |