Provider Demographics
NPI:1588298426
Name:HA, HUY BRYAN DANG
Entity type:Individual
Prefix:
First Name:HUY BRYAN
Middle Name:DANG
Last Name:HA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11031 WOODBURY RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-3531
Mailing Address - Country:US
Mailing Address - Phone:714-854-2773
Mailing Address - Fax:
Practice Address - Street 1:16800 ASTON STE 175
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-4820
Practice Address - Country:US
Practice Address - Phone:714-854-2773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-01
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician