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General NPI Number Information
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NPI Number | 1700153665
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Entity Type | Organization
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Legal Business Name | WELLNESS PAIN CENTER, INC.
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Dates
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Enumeration Date | 11/21/2011
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Last Update Date | 11/21/2011
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Provider Practice Location Address
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Address Line | 14362 BROOKHURST ST
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City | GARDEN GROVE
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State | CA
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Zip | 92843-4608
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Country | US
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Telephone | 714-531-7830
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Fax |
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Provider Business Mailing Address
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Address Line | 14362 BROOKHURST ST
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City | GARDEN GROVE
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State | CA
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Zip | 92843-4608
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Country | US
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Telephone | 714-531-7830
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Fax |
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Authorized Official
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Title or Position | CEO/PHYSICIAN
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Name | DR. MICHAEL DAO
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Credential | M.D.
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Telephone | 714-531-7830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A87942
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License Number State | CA
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