Provider Demographics
NPI:1902684004
Name:DIEP, BE THI (DC, ATC)
Entity Type:Individual
Prefix:
First Name:BE
Middle Name:THI
Last Name:DIEP
Suffix:
Gender:F
Credentials:DC, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17461 IRVINE BLVD STE P
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3026
Mailing Address - Country:US
Mailing Address - Phone:949-929-0585
Mailing Address - Fax:
Practice Address - Street 1:17461 IRVINE BLVD STE P
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3026
Practice Address - Country:US
Practice Address - Phone:949-929-0585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20000527162255A2300X
CADC36763111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer