Healthcare Provider Details

I. General information

NPI: 1235387663
Provider Name (Legal Business Name): KHUONG DAO AA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6720 BERTNER AVE
HOUSTON TX
77030-2604
US

IV. Provider business mailing address

6720 BERTNER AVE STE O-520
HOUSTON TX
77030-2604
US

V. Phone/Fax

Practice location:
  • Phone: 832-355-2666
  • Fax:
Mailing address:
  • Phone: 832-355-2666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number865
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: