Healthcare Provider Details

I. General information

NPI: 1891066262
Provider Name (Legal Business Name): DAO REFELA DENTAL PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 E HUNTINGTON DR STE 201
MONROVIA CA
91016-3612
US

IV. Provider business mailing address

831 E HUNTINGTON DR STE 201
MONROVIA CA
91016-3612
US

V. Phone/Fax

Practice location:
  • Phone: 626-359-8300
  • Fax: 626-359-8311
Mailing address:
  • Phone: 626-359-8300
  • Fax: 626-359-8311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number59625
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number53902
License Number StateCA

VIII. Authorized Official

Name: DR. LAN B DAO
Title or Position: OWNER
Credential: D.D.S.
Phone: 310-699-0775