Provider Demographics
NPI:1376710913
Name:TRIEU, DIANE NGAN (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:NGAN
Last Name:TRIEU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 LAPALCO BLVD STE 20
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-5738
Mailing Address - Country:US
Mailing Address - Phone:504-517-2025
Mailing Address - Fax:504-517-2027
Practice Address - Street 1:1525 LAPALCO BLVD STE 20
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-5738
Practice Address - Country:US
Practice Address - Phone:504-517-2025
Practice Address - Fax:504-517-2027
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ9754207N00000X, 207ND0101X
LAMD.203192207N00000X, 207NS0135X, 207ND0101X
LA203192208D00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program