Healthcare Provider Details

I. General information

NPI: 1235185075
Provider Name (Legal Business Name): TRUC HUY DAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 09/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13071 BROOKHURST ST STE 180
GARDEN GROVE CA
92843-1097
US

IV. Provider business mailing address

13071 BROOKHURST ST STE 180
GARDEN GROVE CA
92843-1097
US

V. Phone/Fax

Practice location:
  • Phone: 714-519-8306
  • Fax: 714-534-7246
Mailing address:
  • Phone: 714-519-8306
  • Fax: 714-534-7246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA50341
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA50341
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: