Provider Demographics
NPI:1538372487
Name:DIEP, DAN TUAN (DC)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:TUAN
Last Name:DIEP
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10423 VALLEY BLVD
Mailing Address - Street 2:STE D
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2460
Mailing Address - Country:US
Mailing Address - Phone:626-575-1211
Mailing Address - Fax:626-575-1511
Practice Address - Street 1:10423 VALLEY BLVD
Practice Address - Street 2:STE D
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2460
Practice Address - Country:US
Practice Address - Phone:626-575-1211
Practice Address - Fax:626-575-1511
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27598111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0275980OtherBLUE SHIELD
CAU86273Medicare UPIN
DC27598Medicare ID - Type Unspecified