Provider Demographics
NPI:1366867327
Name:TRAN-KIM, DIANA (DO)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:TRAN-KIM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11160 WARNER AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VLY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4055
Mailing Address - Country:US
Mailing Address - Phone:714-210-5665
Mailing Address - Fax:714-210-2031
Practice Address - Street 1:11160 WARNER AVE STE 301
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VLY
Practice Address - State:CA
Practice Address - Zip Code:92708-4055
Practice Address - Country:US
Practice Address - Phone:714-210-5665
Practice Address - Fax:714-210-2031
Is Sole Proprietor?:No
Enumeration Date:2014-02-27
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY275009207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program