Healthcare Provider Details

I. General information

NPI: 1962745927
Provider Name (Legal Business Name): KIMBERLY ANN DAO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840HARRISON AVE
BOSTON MA
02118
US

IV. Provider business mailing address

840 HARRISON AVE
BOSTON MA
02118-2905
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-5135
  • Fax:
Mailing address:
  • Phone: 617-638-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number274553
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: