Provider Demographics
NPI:1902177066
Name:VIET TRONG DAO MD A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:VIET TRONG DAO MD A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIET
Authorized Official - Middle Name:T
Authorized Official - Last Name:DAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-583-0553
Mailing Address - Street 1:6255 UNIVERSITY AVE
Mailing Address - Street 2:STE A-2
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-5727
Mailing Address - Country:US
Mailing Address - Phone:619-583-0553
Mailing Address - Fax:619-583-5702
Practice Address - Street 1:6255 UNIVERSITY AVE
Practice Address - Street 2:STE A-2
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-5727
Practice Address - Country:US
Practice Address - Phone:619-583-0553
Practice Address - Fax:619-583-5702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-21
Last Update Date:2012-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty