Healthcare Provider Details

I. General information

NPI: 1851107882
Provider Name (Legal Business Name): BAO DAO FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3160 FOLSOM BLVD
SACRAMENTO CA
95816-5202
US

IV. Provider business mailing address

4301 X ST
SACRAMENTO CA
95817-2214
US

V. Phone/Fax

Practice location:
  • Phone: 916-731-1831
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95032774
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: