Provider Demographics
NPI:1073814174
Name:DIEP, CHAN NHU (OD)
Entity Type:Individual
Prefix:DR
First Name:CHAN
Middle Name:NHU
Last Name:DIEP
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11540 SANTA MONICA BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-7905
Mailing Address - Country:US
Mailing Address - Phone:310-473-5464
Mailing Address - Fax:310-473-2536
Practice Address - Street 1:11540 SANTA MONICA BLVD STE 202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025
Practice Address - Country:US
Practice Address - Phone:310-473-5464
Practice Address - Fax:310-473-2536
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-05
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007640152W00000X
CA14049152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist