Healthcare Provider Details

I. General information

NPI: 1336264639
Provider Name (Legal Business Name): NINH ANH DAO D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 03/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 S WHITE RD
SAN JOSE CA
95148-2932
US

IV. Provider business mailing address

2830 S WHITE RD
SAN JOSE CA
95148-2932
US

V. Phone/Fax

Practice location:
  • Phone: 408-238-0212
  • Fax: 408-238-0282
Mailing address:
  • Phone: 408-238-0212
  • Fax: 408-238-0282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number51572
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: