Healthcare Provider Details

I. General information

NPI: 1396461943
Provider Name (Legal Business Name): KRYSTLE YEN DAO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3949 E CHANDLER BLVD
PHOENIX AZ
85048-7335
US

IV. Provider business mailing address

1080 E YELLOWSTONE PL
CHANDLER AZ
85249-5729
US

V. Phone/Fax

Practice location:
  • Phone: 480-706-7373
  • Fax: 480-706-7367
Mailing address:
  • Phone: 602-865-9788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberS026124
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: