Provider Demographics
NPI:1548408412
Name:DIEP, LIEN AI (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:LIEN
Middle Name:AI
Last Name:DIEP
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-2309
Mailing Address - Country:US
Mailing Address - Phone:213-680-1456
Mailing Address - Fax:213-680-9385
Practice Address - Street 1:823 N BROADWAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2309
Practice Address - Country:US
Practice Address - Phone:213-680-1456
Practice Address - Fax:213-680-9385
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-27668111NN1001X
CAAC-8379171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN1001XChiropractic ProvidersChiropractorNutrition
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU90136Medicare UPIN