Healthcare Provider Details

I. General information

NPI: 1811746035
Provider Name (Legal Business Name): DIANA PAJONGVIROTJANASAKUL OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANA PAJONG OD

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5460 E LA PALMA AVE
ANAHEIM CA
92807-2023
US

IV. Provider business mailing address

59 ENDLESS VIS
ALISO VIEJO CA
92656-8057
US

V. Phone/Fax

Practice location:
  • Phone: 714-463-7250
  • Fax:
Mailing address:
  • Phone: 949-288-3680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number35888
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number35888
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number35888
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number009984
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: