Healthcare Provider Details

I. General information

NPI: 1730556689
Provider Name (Legal Business Name): CHRISTINE DAO L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. CHRISTINE ILOVAN

II. Dates (important events)

Enumeration Date: 08/26/2015
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 S LIVERMORE AVE STE B
LIVERMORE CA
94550-4681
US

IV. Provider business mailing address

379 S LIVERMORE AVE STE B
LIVERMORE CA
94550-4681
US

V. Phone/Fax

Practice location:
  • Phone: 510-957-8260
  • Fax: 510-952-8266
Mailing address:
  • Phone: 510-957-8260
  • Fax: 510-952-8266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC16553
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: