Provider Demographics
NPI:1598220113
Name:DAO, NGAN NGOCKIM
Entity Type:Individual
Prefix:
First Name:NGAN
Middle Name:NGOCKIM
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 1:5877 CERVANTES AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-6538
Mailing Address - Country:US
Mailing Address - Phone:714-383-5808
Mailing Address - Fax:
Practice Address - Street 1:5877 CERVANTES AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-6538
Practice Address - Country:US
Practice Address - Phone:714-383-5808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2019-05-16
Deactivation Date:2019-05-09
Deactivation Code:
Reactivation Date:2019-05-15
Provider Licenses
StateLicense IDTaxonomies
CA80127183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist