Provider Demographics
NPI:1306178629
Name:DIEP, JEANIE (DDS)
Entity Type:Individual
Prefix:
First Name:JEANIE
Middle Name:
Last Name:DIEP
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9533 CORTADA ST
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-1003
Mailing Address - Country:US
Mailing Address - Phone:626-500-7949
Mailing Address - Fax:
Practice Address - Street 1:39400 MURRIETA HOT SPRINGS RD
Practice Address - Street 2:SUITE 123-B
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-7707
Practice Address - Country:US
Practice Address - Phone:951-461-7470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58730122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist