Healthcare Provider Details

I. General information

NPI: 1497823165
Provider Name (Legal Business Name): ALBERT CHUONG DAO D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 OAK ST STE C4
OAKLAND CA
94607-4635
US

IV. Provider business mailing address

311 OAK ST STE C4
OAKLAND CA
94607-4635
US

V. Phone/Fax

Practice location:
  • Phone: 510-839-2828
  • Fax:
Mailing address:
  • Phone: 510-839-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number48898
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: