MEDICARE: DR. DAVID G DAI M.O.D, L.AC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	132-055	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	963	OTHER		NCCAOM

General Provider Information

NPI Number	:	1558640979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID G DAI M.O.D, L.AC

Provider Business Mailing Address
First Line	:	7020 W NORTH AVE
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53213-1943
Country	:	US
Telephone Number	:	414-476-8388
Fax Number	:

Provider Business Practice Location Address
First Line	:	7020 W NORTH AVE
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53213-1943
Country	:	US
Telephone Number	:	414-476-8388
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2011
Last Update Date	:	08/16/2011

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