Provider Demographics
NPI:1427230838
Name:KHIEM D. DAO, MD, INC.
Entity Type:Organization
Organization Name:KHIEM D. DAO, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAYDE
Authorized Official - Middle Name:
Authorized Official - Last Name:YASUKAWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-999-0280
Mailing Address - Street 1:2314 NEWPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-1548
Mailing Address - Country:US
Mailing Address - Phone:949-999-0280
Mailing Address - Fax:949-999-0284
Practice Address - Street 1:2314 NEWPORT BLVD
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-1548
Practice Address - Country:US
Practice Address - Phone:949-999-0280
Practice Address - Fax:949-999-0284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83781207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH68995Medicare UPIN