Provider Demographics
NPI:1699700112
Name:KYDAO,MD,INC
Entity type:Organization
Organization Name:KYDAO,MD,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-638-9119
Mailing Address - Street 1:13918 BROOKHURST ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4332
Mailing Address - Country:US
Mailing Address - Phone:714-638-9119
Mailing Address - Fax:714-638-0429
Practice Address - Street 1:13918 BROOKHURST ST
Practice Address - Street 2:SUITE B
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4332
Practice Address - Country:US
Practice Address - Phone:714-638-9119
Practice Address - Fax:714-638-0429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44188174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty