Healthcare Provider Details

I. General information

NPI: 1801984596
Provider Name (Legal Business Name): BUP THI DAO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LE DAO M.D.

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/08/2007
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: 714-839-8282
  • Fax: 714-962-5956
Mailing address:
  • Phone: 714-839-8282
  • Fax: 714-962-5956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA044435
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: