Provider Demographics
NPI:1285635672
Name:NGHIEM, DAI DAO (MD)
Entity Type:Individual
Prefix:
First Name:DAI
Middle Name:DAO
Last Name:NGHIEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 STOCKTON BLVD # 2021
Mailing Address - Street 2:UC DAVIS MEDICAL CENTER
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2201
Mailing Address - Country:US
Mailing Address - Phone:916-734-7882
Mailing Address - Fax:916-734-6564
Practice Address - Street 1:2315 STOCKTON BLVD # 2021
Practice Address - Street 2:UC DAVIS MEDICAL CENTER
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2201
Practice Address - Country:US
Practice Address - Phone:916-734-7882
Practice Address - Fax:916-734-6564
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037728E208600000X
PAMD-037728-E204F00000X
CAC52961204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0165744Medicaid
WV0222598000Medicaid
PA0010746440001Medicaid
PA110404NJ8Medicare PIN
PA020044331Medicare PIN