MEDICARE: MAILAN DAO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	61679	CA

General Provider Information

NPI Number	:	1235614884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAILAN DAO

Provider Business Mailing Address
First Line	:	321 W SUNNYOAKS AVE
Second Line	:
City	:	CAMPBELL
State	:	CA
Zip	:	95008-5325
Country	:	US
Telephone Number	:	408-666-5039
Fax Number	:

Provider Business Practice Location Address
First Line	:	725 E SANTA CLARA ST STE 202
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95112-1936
Country	:	US
Telephone Number	:	408-794-0565
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2018
Last Update Date	:	09/29/2018

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Directions to “ MAILAN DAO ” Practice Location

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