Provider Demographics
NPI:1356505721
Name:MA, DANG KHOA BRYAN (OD)
Entity Type:Individual
Prefix:DR
First Name:DANG KHOA
Middle Name:BRYAN
Last Name:MA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:BRYAN
Other - Middle Name:
Other - Last Name:MA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:2836E CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-3200
Mailing Address - Country:US
Mailing Address - Phone:714-288-8855
Mailing Address - Fax:714-288-8895
Practice Address - Street 1:2836 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-3200
Practice Address - Country:US
Practice Address - Phone:714-288-8855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13525152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist