Healthcare Provider Details

I. General information

NPI: 1437359403
Provider Name (Legal Business Name): HOANGSON H. DAO DDS. A PROF. DENTAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 07/18/2007
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: 714-636-3115
Mailing address:
  • Phone: 714-636-3137
  • Fax: 714-636-3115

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: DR. HOANGSON DAO
Title or Position: CEO
Credential: DDS
Phone: 714-636-3137