=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164908018
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAOUD DDS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2018
-----------------------------------------------------
Last Update Date | 07/13/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 952 S ATLANTIC BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90022-4004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-263-9600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5941 BURNHAM AVE
-----------------------------------------------------
City | BUENA PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90621-1821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-877-0754
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | KHALED DAOUD
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 323-263-9600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | DDS100685
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------