Provider Demographics
NPI:1881222636
Name:DAO, TUNG VAN (DPM, MS)
Entity type:Individual
Prefix:DR
First Name:TUNG
Middle Name:VAN
Last Name:DAO
Suffix:
Gender:M
Credentials:DPM, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6480 HARRISON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-7961
Mailing Address - Country:US
Mailing Address - Phone:513-818-0043
Mailing Address - Fax:513-964-9575
Practice Address - Street 1:2750 NEWARK GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-9142
Practice Address - Country:US
Practice Address - Phone:740-788-9220
Practice Address - Fax:740-788-9226
Is Sole Proprietor?:No
Enumeration Date:2020-03-28
Last Update Date:2024-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5927213ES0103X
OH36.004148213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH36.004148OtherOHIO STATE MEDICAL LICENSE #