Healthcare Provider Details

I. General information

NPI: 1548288822
Provider Name (Legal Business Name): ANGELINE THI DAO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17742 BEACH BLVD STE 301
HUNTINGTON BEACH CA
92647-6853
US

IV. Provider business mailing address

17742 BEACH BLVD STE 301
HUNTINGTON BEACH CA
92647-6853
US

V. Phone/Fax

Practice location:
  • Phone: 714-897-7546
  • Fax: 714-897-7549
Mailing address:
  • Phone: 714-897-7546
  • Fax: 714-897-7549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA371990
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA371990
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: