Healthcare Provider Details

I. General information

NPI: 1639119886
Provider Name (Legal Business Name): KIM V. DAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

806 E JULIAN ST A
SAN JOSE CA
95112-1869
US

IV. Provider business mailing address

806 E JULIAN ST A
SAN JOSE CA
95112-1869
US

V. Phone/Fax

Practice location:
  • Phone: 408-295-5170
  • Fax: 408-295-0601
Mailing address:
  • Phone: 408-295-5170
  • Fax: 408-295-0601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberA50097
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: