Healthcare Provider Details

I. General information

NPI: 1356943294
Provider Name (Legal Business Name): LINH PHUONG DAO DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2020
Last Update Date: 11/16/2020
Certification Date: 11/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N. HARBOR BVLD.
ANAHEIM CA
92805
US

IV. Provider business mailing address

215 N. HARBOR BVLD.
ANAHEIM CA
92805
US

V. Phone/Fax

Practice location:
  • Phone: 408-368-6880
  • Fax:
Mailing address:
  • Phone: 408-368-6880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF09200632
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: