Provider Demographics
NPI:1235633504
Name:DAO, KIMBERLY
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
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 1:8839 BRYAN DAIRY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33777-1207
Mailing Address - Country:US
Mailing Address - Phone:727-394-5650
Mailing Address - Fax:813-635-7939
Practice Address - Street 1:8839 BRYAN DAIRY RD STE 200
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33777-1207
Practice Address - Country:US
Practice Address - Phone:727-394-5650
Practice Address - Fax:813-635-7939
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD61071694207Q00000X
390200000X
FLME154870207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program