Provider Demographics
NPI:1467542175
Name:DAO, MARC K (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:K
Last Name:DAO
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 1:2185 CITRACADO PKWY
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92029-4159
Mailing Address - Country:US
Mailing Address - Phone:414-719-0656
Mailing Address - Fax:
Practice Address - Street 1:332 S JUNIPER ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4940
Practice Address - Country:US
Practice Address - Phone:760-291-6650
Practice Address - Fax:760-737-3430
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48006207R00000X
TXN6851207R00000X
CAC142559207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34660200Medicaid
TX215615001Medicaid
TX215615003Medicaid
TX215615002Medicaid
TXP00869618Medicare PIN
TX215615001Medicaid
TXTXB154730Medicare PIN
TXP01215263Medicare PIN
WI34660200Medicaid
TXTXB154724Medicare PIN