Provider Demographics
NPI:1811089485
Name:THEIN, DIANA KHAW (OD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:KHAW
Last Name:THEIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24692 DEL PRADO
Mailing Address - Street 2:SUITE B
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3841
Mailing Address - Country:US
Mailing Address - Phone:949-661-8884
Mailing Address - Fax:
Practice Address - Street 1:24692 DEL PRADO
Practice Address - Street 2:SUITE B
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-3841
Practice Address - Country:US
Practice Address - Phone:949-661-8884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2025-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10426T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0104260Medicaid
CAOP10426Medicare ID - Type Unspecified
CASD0104260Medicaid