Provider Demographics
NPI:1548288822
Name:DAO, ANGELINE THI (MD)
Entity type:Individual
Prefix:
First Name:ANGELINE
Middle Name:THI
Last Name:DAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17742 BEACH BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-6853
Mailing Address - Country:US
Mailing Address - Phone:714-897-7546
Mailing Address - Fax:714-897-7549
Practice Address - Street 1:17742 BEACH BLVD STE 301
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-6853
Practice Address - Country:US
Practice Address - Phone:714-897-7546
Practice Address - Fax:714-897-7549
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA371990174400000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA84982Medicare UPIN
CAA84982Medicare UPIN
CA84982Medicare ID - Type Unspecified