Healthcare Provider Details

I. General information

NPI: 1730379314
Provider Name (Legal Business Name): LOAN K DAO D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 10/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 W FOOTHILL BLVD
GLENDORA CA
91741-3363
US

IV. Provider business mailing address

455 W FOOTHILL BLVD
GLENDORA CA
91741-3363
US

V. Phone/Fax

Practice location:
  • Phone: 626-914-9808
  • Fax: 626-914-9808
Mailing address:
  • Phone: 714-878-7748
  • Fax: 714-891-0685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number55907
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD7333
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: