Provider Demographics
NPI:1821104423
Name:DAO, TRUNG DUY (MD)
Entity Type:Individual
Prefix:DR
First Name:TRUNG
Middle Name:DUY
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 1:10551 CRAWFORD CANYON RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-1416
Mailing Address - Country:US
Mailing Address - Phone:714-300-8539
Mailing Address - Fax:714-898-8226
Practice Address - Street 1:9211 BOLSA AVE
Practice Address - Street 2:SUITE 217
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5567
Practice Address - Country:US
Practice Address - Phone:714-898-7886
Practice Address - Fax:714-898-8226
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42590174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB50499Medicare UPIN