Healthcare Provider Details

I. General information

NPI: 1295299071
Provider Name (Legal Business Name): CHRISTINE DAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6135 S 90TH EAST AVE
TULSA OK
74133-6365
US

IV. Provider business mailing address

6135 S 90TH EAST AVE
TULSA OK
74133-6365
US

V. Phone/Fax

Practice location:
  • Phone: 539-367-1145
  • Fax: 539-367-1224
Mailing address:
  • Phone: 539-367-1145
  • Fax: 539-367-1224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2884
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: