Healthcare Provider Details

I. General information

NPI: 1982123360
Provider Name (Legal Business Name): HUYEN DAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2017
Last Update Date: 09/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5560 OVERLAND AVE STE 202
SAN DIEGO CA
92123-1204
US

IV. Provider business mailing address

5560 OVERLAND AVE STE 202
SAN DIEGO CA
92123-1204
US

V. Phone/Fax

Practice location:
  • Phone: 858-505-6626
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number95096728
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: