Provider Demographics
NPI:1376066167
Name:DAO, TREVOR KHUONG CHENG (OD)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:KHUONG CHENG
Last Name:DAO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56970 YUCCA TRL STE 101
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-7911
Mailing Address - Country:US
Mailing Address - Phone:760-228-2020
Mailing Address - Fax:
Practice Address - Street 1:56970 YUCCA TRL STE 101
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-7911
Practice Address - Country:US
Practice Address - Phone:760-228-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA33714152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program