Healthcare Provider Details

I. General information

NPI: 1568912764
Provider Name (Legal Business Name): MICHAEL DAI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 ADELINE ST
BERKELEY CA
94703-2204
US

IV. Provider business mailing address

5268 NOYACK WAY
SACRAMENTO CA
95835-2631
US

V. Phone/Fax

Practice location:
  • Phone: 510-981-8392
  • Fax:
Mailing address:
  • Phone: 925-876-6522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number75023
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: