Provider Demographics
NPI:1558689950
Name:DIEP, ANTHONY KIM (RPVI)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:KIM
Last Name:DIEP
Suffix:
Gender:M
Credentials:RPVI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7109 N. ARMENIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-5262
Mailing Address - Country:US
Mailing Address - Phone:813-990-8500
Mailing Address - Fax:813-990-8600
Practice Address - Street 1:7109 N. ARMENIA AVENUE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-5262
Practice Address - Country:US
Practice Address - Phone:813-990-8500
Practice Address - Fax:813-990-8600
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-10
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1218232085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound