Provider Demographics
NPI:1346535507
Name:DIRKSEN, KATE DIEP (PA-C)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:DIEP
Last Name:DIRKSEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:DIEP
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:39141 CIVIC CENTER DR
Mailing Address - Street 2:SUITE 335
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-5818
Mailing Address - Country:US
Mailing Address - Phone:510-248-1400
Mailing Address - Fax:510-797-0301
Practice Address - Street 1:39141 CIVIC CENTER DR
Practice Address - Street 2:SUITE 335
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-5818
Practice Address - Country:US
Practice Address - Phone:510-248-1400
Practice Address - Fax:510-797-0301
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21594363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA35-2283750Medicare PIN