Healthcare Provider Details

I. General information

NPI: 1306385646
Provider Name (Legal Business Name): ROBERT DAO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2017
Last Update Date: 11/29/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11115 S MAIN ST, LOS ANGELES, CA
LOS ANGELES CA
90039
US

IV. Provider business mailing address

1 MAIN ST
IRVINE CA
92617
US

V. Phone/Fax

Practice location:
  • Phone: 323-757-2263
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number76019
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: