Provider Demographics
NPI:1215223136
Name:DAO, TAM VAN (MD)
Entity Type:Individual
Prefix:DR
First Name:TAM
Middle Name:VAN
Last Name:DAO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11660 CHURCH ST
Mailing Address - Street 2:APT 381
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-8917
Mailing Address - Country:US
Mailing Address - Phone:623-565-3041
Mailing Address - Fax:
Practice Address - Street 1:9961 SIERRA AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-6720
Practice Address - Country:US
Practice Address - Phone:909-427-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301099098207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301099098OtherDEPARTMENT OF LICENSING AND REGULATION AFFAIRS
CAA127845OtherTHE MEDICAL BOARD OF CALIFORNIA