Healthcare Provider Details

I. General information

NPI: 1164908018
Provider Name (Legal Business Name): DAOUD DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2018
Last Update Date: 07/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

952 S ATLANTIC BLVD
LOS ANGELES CA
90022-4004
US

IV. Provider business mailing address

5941 BURNHAM AVE
BUENA PARK CA
90621-1821
US

V. Phone/Fax

Practice location:
  • Phone: 323-263-9600
  • Fax:
Mailing address:
  • Phone: 412-877-0754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDDS100685
License Number StateCA

VIII. Authorized Official

Name: KHALED DAOUD
Title or Position: PRESIDENT
Credential: DDS
Phone: 323-263-9600