Provider Demographics
NPI:1528390275
Name:DIEP, VIVIAN THUTRANG (LAC)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:THUTRANG
Last Name:DIEP
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 NORTH CATALINA AVE.
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106
Mailing Address - Country:US
Mailing Address - Phone:626-429-6829
Mailing Address - Fax:
Practice Address - Street 1:449 N CATALINA AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1087
Practice Address - Country:US
Practice Address - Phone:626-429-6829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8358171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist