Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | A50097 | CA |
NPI | 1639119886 |
---|---|
Provider Name | Kim V. Dao |
First Address | San Jose, CA 95112-1869 |
Second Address | San Jose, CA 95112-1869 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 08/07/2007 |