Provider Demographics
NPI:1386205235
Name:DIEP, JASON DO (DMD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:DO
Last Name:DIEP
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2738 STRATHMORE AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-3166
Mailing Address - Country:US
Mailing Address - Phone:626-321-7337
Mailing Address - Fax:
Practice Address - Street 1:311 WINSTON ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-1519
Practice Address - Country:US
Practice Address - Phone:626-321-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103830122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist