Provider Demographics
NPI:1003124264
Name:DAO, PHUONG-THAO THI (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHUONG-THAO
Middle Name:THI
Last Name:DAO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14700 VAN NESS AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-3700
Mailing Address - Country:US
Mailing Address - Phone:310-516-0271
Mailing Address - Fax:
Practice Address - Street 1:15717 PARAMOUNT BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-4377
Practice Address - Country:US
Practice Address - Phone:562-602-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA598311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice