Healthcare Provider Details

I. General information

NPI: 1841606886
Provider Name (Legal Business Name): HUNG DAO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20321 SUSAN LESLIE DR
ASHBURN VA
20147-5682
US

IV. Provider business mailing address

14211 LOTUS LN APT 511
CENTREVILLE VA
20120-6368
US

V. Phone/Fax

Practice location:
  • Phone: 703-726-8647
  • Fax:
Mailing address:
  • Phone: 703-362-1033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202213131
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: