Healthcare Provider Details

I. General information

NPI: 1932305034
Provider Name (Legal Business Name): QUYEN DAO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17542 17TH ST SUITE 410
TUSTIN CA
92780-1959
US

IV. Provider business mailing address

17542 17TH ST SUITE 410
TUSTIN CA
92780-1959
US

V. Phone/Fax

Practice location:
  • Phone: 714-835-9550
  • Fax:
Mailing address:
  • Phone: 714-835-9550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License NumberA85506
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA85506
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: