Provider Demographics
NPI:1033678487
Name:DAO, QUOC-HIEP PHAN (DENTAL HYGIENIST)
Entity Type:Individual
Prefix:
First Name:QUOC-HIEP
Middle Name:PHAN
Last Name:DAO
Suffix:
Gender:M
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13691 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-3230
Mailing Address - Country:US
Mailing Address - Phone:714-251-3793
Mailing Address - Fax:
Practice Address - Street 1:13691 CYPRESS ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-3230
Practice Address - Country:US
Practice Address - Phone:714-251-3793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31952124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA31952OtherDENTAL HYGIENE