Healthcare Provider Details

I. General information

NPI: 1558354712
Provider Name (Legal Business Name): TRUNG NGUYEN DAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 W CAMPBELL RD #212
RICHARDSON TX
75080-3595
US

IV. Provider business mailing address

399 W CAMPBELL RD SUITE 212
RICHARDSON TX
75080-3595
US

V. Phone/Fax

Practice location:
  • Phone: 972-234-4994
  • Fax: 972-234-4412
Mailing address:
  • Phone: 972-234-4994
  • Fax: 972-234-4412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberK0013
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: