Provider Demographics
NPI:1467425223
Name:TIET, JENNY-QUYEN BICH (OD)
Entity Type:Individual
Prefix:
First Name:JENNY-QUYEN
Middle Name:BICH
Last Name:TIET
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10353 LAKEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-2743
Mailing Address - Country:US
Mailing Address - Phone:562-923-5501
Mailing Address - Fax:562-923-8863
Practice Address - Street 1:10353 LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-2743
Practice Address - Country:US
Practice Address - Phone:562-923-5501
Practice Address - Fax:562-923-8863
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11489T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0114890Medicaid
CASD0114890Medicaid
V01638Medicare UPIN