Provider Demographics
NPI:1477986412
Name:NGUYEN, DIANA LIEN CHI
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:LIEN CHI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 WOOLSEY ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-2324
Mailing Address - Country:US
Mailing Address - Phone:408-568-4549
Mailing Address - Fax:
Practice Address - Street 1:1600 WOOLSEY ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-2324
Practice Address - Country:US
Practice Address - Phone:408-568-4549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF1162480390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program