Healthcare Provider Details

I. General information

NPI: 1699466102
Provider Name (Legal Business Name): KATHY DAO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4955 VAN NUYS BLVD STE 615
SHERMAN OAKS CA
91403-1839
US

IV. Provider business mailing address

7910 1ST ST APT H
STANTON CA
90680-1690
US

V. Phone/Fax

Practice location:
  • Phone: 818-905-2222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number62983
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: