Healthcare Provider Details

I. General information

NPI: 1235233503
Provider Name (Legal Business Name): ANDY DUC DAO D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 11/10/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANDSTUHL REGIONAL MEDICAL CENTER UNIT 33100
APO NY
09180
US

IV. Provider business mailing address

8722 FINLANDIA GAP
SAN ANTONIO TX
78251-4998
US

V. Phone/Fax

Practice location:
  • Phone: 213-581-6555
  • Fax:
Mailing address:
  • Phone: 213-581-6555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4671
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: