Healthcare Provider Details

I. General information

NPI: 1043402621
Provider Name (Legal Business Name): LE DAO MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14554 BROOKHURST ST
WESTMINSTER CA
92683-5750
US

IV. Provider business mailing address

14554 BROOKHURST ST
WESTMINSTER CA
92683-5750
US

V. Phone/Fax

Practice location:
  • Phone: 714-839-0763
  • Fax:
Mailing address:
  • Phone: 714-839-0763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA44435
License Number StateCA

VIII. Authorized Official

Name: DR. LE BUP THI DAO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-839-8282