Healthcare Provider Details

I. General information

NPI: 1770167413
Provider Name (Legal Business Name): KAYLA MARIE WHITE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1403 N TUSTIN AVE STE 399
SANTA ANA CA
92705-8691
US

IV. Provider business mailing address

2351 ERWIN RD
DURHAM NC
27705-4699
US

V. Phone/Fax

Practice location:
  • Phone: 714-884-3961
  • Fax: 714-884-3458
Mailing address:
  • Phone: 919-681-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA209098
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: