Healthcare Provider Details

I. General information

NPI: 1265739981
Provider Name (Legal Business Name): CHARLES DAI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2011
Last Update Date: 02/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8945 MAGNOLIA AVE STE 200
RIVERSIDE CA
92503-4436
US

IV. Provider business mailing address

PO BOX 148
CLAREMONT CA
91711-0148
US

V. Phone/Fax

Practice location:
  • Phone: 951-688-7270
  • Fax:
Mailing address:
  • Phone: 909-985-2112
  • Fax: 909-985-3411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA75228
License Number StateCA

VIII. Authorized Official

Name: CHARLES B. DAI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 909-985-2112