Healthcare Provider Details

I. General information

NPI: 1134275472
Provider Name (Legal Business Name): HOANGSON H DAO D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13211 HARBOR BLVD
GARDEN GROVE CA
92843-1719
US

IV. Provider business mailing address

13211 HARBOR BLVD
GARDEN GROVE CA
92843-1719
US

V. Phone/Fax

Practice location:
  • Phone: 714-636-3137
  • Fax:
Mailing address:
  • Phone: 714-636-3137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number43931
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: