Healthcare Provider Details

I. General information

NPI: 1356028708
Provider Name (Legal Business Name): NGA DAO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 THOMAS RD STE 203
SANTA CLARA CA
95054-2063
US

IV. Provider business mailing address

4125 VISTAPARK DR
SAN JOSE CA
95136-2039
US

V. Phone/Fax

Practice location:
  • Phone: 408-703-5085
  • Fax:
Mailing address:
  • Phone: 408-667-3687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113142
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: