Provider Demographics
NPI:1558640979
Name:DAI, DAVID G (MOD, LAC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:G
Last Name:DAI
Suffix:
Gender:M
Credentials:MOD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7020 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-1943
Mailing Address - Country:US
Mailing Address - Phone:414-476-8388
Mailing Address - Fax:
Practice Address - Street 1:7020 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-1943
Practice Address - Country:US
Practice Address - Phone:414-476-8388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI132-055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
963OtherNCCAOM