Healthcare Provider Details

I. General information

NPI: 1063156487
Provider Name (Legal Business Name): TRACIE DANG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9549 GIDLEY ST
TEMPLE CITY CA
91780-4214
US

IV. Provider business mailing address

9549 GIDLEY ST
TEMPLE CITY CA
91780-4214
US

V. Phone/Fax

Practice location:
  • Phone: 626-636-6544
  • Fax:
Mailing address:
  • Phone: 626-636-6544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number20A25381
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number336443
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: