Provider Demographics
NPI:1306421573
Name:SOE, BRYAN THIHA
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:THIHA
Last Name:SOE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20230 KLINE LN
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-3269
Mailing Address - Country:US
Mailing Address - Phone:714-337-2561
Mailing Address - Fax:
Practice Address - Street 1:1616 E MAYFAIR AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-7055
Practice Address - Country:US
Practice Address - Phone:714-744-8164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
124Q00000X
CA33892124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist