Healthcare Provider Details

I. General information

NPI: 1285635672
Provider Name (Legal Business Name): DAI DAO NGHIEM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 03/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 STOCKTON BLVD # 2021 UC DAVIS MEDICAL CENTER
SACRAMENTO CA
95817-2201
US

IV. Provider business mailing address

2315 STOCKTON BLVD # 2021 UC DAVIS MEDICAL CENTER
SACRAMENTO CA
95817-2201
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-7882
  • Fax: 916-734-6564
Mailing address:
  • Phone: 916-734-7882
  • Fax: 916-734-6564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD037728E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License NumberMD-037728-E
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License NumberC52961
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: