MEDICARE: KHOA DAO

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	183500000X	Pharmacist	64900	CA

General Provider Information

NPI Number	:	1851681506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KHOA DAO

Provider Business Mailing Address
First Line	:	2003 EVELETH AVE
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94577-3318
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1355 MACARTHUR BLVD
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94577-3918
Country	:	US
Telephone Number	:	510-352-3677
Fax Number	:

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

Provider Enumeration Date	:	04/14/2011
Last Update Date	:	04/14/2011

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Directions to “ KHOA DAO ” Practice Location

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