Provider Demographics
NPI:1346509213
Name:UY, BRYANT DAVIS (PA-C)
Entity Type:Individual
Prefix:
First Name:BRYANT
Middle Name:DAVIS
Last Name:UY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10539 LE CONTE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-3305
Mailing Address - Country:US
Mailing Address - Phone:310-470-9670
Mailing Address - Fax:
Practice Address - Street 1:8737 BEVERLY BLVD STE 302
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1839
Practice Address - Country:US
Practice Address - Phone:310-659-9959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22077363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant