Healthcare Provider Details

I. General information

NPI: 1912692450
Provider Name (Legal Business Name): DANNY TRI-DANG DAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 SAINT MARKS PLZ STE 9
STOCKTON CA
95207-6411
US

IV. Provider business mailing address

183 BUTCHER RD STE A
VACAVILLE CA
95687-5691
US

V. Phone/Fax

Practice location:
  • Phone: 209-451-4570
  • Fax:
Mailing address:
  • Phone: 707-724-6810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: