Provider Demographics
NPI:1083217806
Name:DAO, MARY HONG
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:HONG
Last Name:DAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5653 DULUTH ST
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4054
Mailing Address - Country:US
Mailing Address - Phone:612-873-6963
Mailing Address - Fax:612-873-1690
Practice Address - Street 1:5653 DULUTH ST
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4054
Practice Address - Country:US
Practice Address - Phone:612-873-6963
Practice Address - Fax:612-873-1690
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7688363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7688Medicaid