Provider Demographics
NPI:1316914294
Name:DO, KHA TU (OD)
Entity type:Individual
Prefix:
First Name:KHA
Middle Name:TU
Last Name:DO
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 1:516 SAINT VINCENT
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3925
Mailing Address - Country:US
Mailing Address - Phone:714-747-6336
Mailing Address - Fax:
Practice Address - Street 1:6850 LINCOLN AVE STE 204
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-4180
Practice Address - Country:US
Practice Address - Phone:714-927-5192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12565T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV06979Medicare UPIN