Provider Demographics
NPI:1346465408
Name:DIEP, KIMBERLY A (DC)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:A
Last Name:DIEP
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10476 VALLEY BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2459
Mailing Address - Country:US
Mailing Address - Phone:626-279-9041
Mailing Address - Fax:626-279-9043
Practice Address - Street 1:10476 VALLEY BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2459
Practice Address - Country:US
Practice Address - Phone:626-279-9041
Practice Address - Fax:626-279-9043
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28563111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor