Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A119273 | CA |
NPI | 1003185885 |
---|---|
Provider Name | Tri Duy Dao |
First Address | Mission Hills, CA 91346-9602 |
Second Address | Burbank, CA 91505-4554 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2011 |
Last Update Date | 26/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A1192730 | (05) | CA |