MEDICARE: VIET TRONG DAO M.D.

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	207Q00000X	Family Medicine Physician	A96409	CA

General Provider Information

NPI Number	:	1861406225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIET TRONG DAO M.D.

Provider Business Mailing Address
First Line	:	4616 EL CAJON BLVD STE 9
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4426
Country	:	US
Telephone Number	:	951-303-8234
Fax Number	:	951-303-8234

Provider Business Practice Location Address
First Line	:	4616 EL CAJON BLVD STE 9
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4426
Country	:	US
Telephone Number	:	619-583-0553
Fax Number	:	619-583-5702

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	02/21/2020

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