Healthcare Provider Details

I. General information

NPI: 1093725772
Provider Name (Legal Business Name): UYEN K. DAO D.P.M
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 07/31/2020
Certification Date: 07/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17820 SE 109TH AVE STE 102
SUMMERFIELD FL
34491-8968
US

IV. Provider business mailing address

17820 SE 109TH AVE STE 102
SUMMERFIELD FL
34491-8968
US

V. Phone/Fax

Practice location:
  • Phone: 352-347-3338
  • Fax: 352-347-3389
Mailing address:
  • Phone: 352-347-3338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO2852
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: