Provider Demographics
NPI:1699779389
Name:DAO, HIEN (MD)
Entity type:Individual
Prefix:
First Name:HIEN
Middle Name:
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 1:1000 MAR WALT DR
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6708
Mailing Address - Country:US
Mailing Address - Phone:850-315-4249
Mailing Address - Fax:866-315-4258
Practice Address - Street 1:1000 MAR WALT DR
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6708
Practice Address - Country:US
Practice Address - Phone:850-315-4249
Practice Address - Fax:866-315-4258
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79705207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267192100Medicaid
FL49694OtherBCBS
AL059188122OtherBCBS
FL258396800Medicaid
FLP00336138Medicare PIN
AL059188122OtherBCBS
FL258396800Medicaid
FL49694OtherBCBS
FLH11745Medicare UPIN