Healthcare Provider Details

I. General information

NPI: 1578134862
Provider Name (Legal Business Name): KHANH DAO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16455 E AVENUE OF THE FOUNTAINS
FOUNTAIN HILLS AZ
85268-8307
US

IV. Provider business mailing address

1265 E UNIVERSITY DR APT 2069
TEMPE AZ
85281-8448
US

V. Phone/Fax

Practice location:
  • Phone: 480-770-6990
  • Fax:
Mailing address:
  • Phone: 619-278-9178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: