Healthcare Provider Details

I. General information

NPI: 1881222636
Provider Name (Legal Business Name): TUNG VAN DAO DPM, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2020
Last Update Date: 08/11/2024
Certification Date: 08/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 NEWARK GRANVILLE RD
GRANVILLE OH
43023-9142
US

IV. Provider business mailing address

6480 HARRISON AVE STE 201
CINCINNATI OH
45247-7961
US

V. Phone/Fax

Practice location:
  • Phone: 740-788-9220
  • Fax: 740-788-9226
Mailing address:
  • Phone: 513-818-0043
  • Fax: 513-964-9575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE5927
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number36.004148
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: