Healthcare Provider Details

I. General information

NPI: 1265142988
Provider Name (Legal Business Name): DAVID THI DAO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 MARENGO ST
LOS ANGELES CA
90033-1352
US

IV. Provider business mailing address

13741 BEWLEY ST
GARDEN GROVE CA
92843-4003
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-7641
  • Fax:
Mailing address:
  • Phone: 714-350-6844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number84709
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: