Provider Demographics
NPI:1639465446
Name:BANH, DIEM PHUC THUC (DO)
Entity Type:Individual
Prefix:DR
First Name:DIEM PHUC
Middle Name:THUC
Last Name:BANH
Suffix:
Gender:F
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:26520 CACTUS AVE
Mailing Address - Street 2:GME OFFICE ROOM A1005
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-3927
Mailing Address - Country:US
Mailing Address - Phone:951-486-5908
Mailing Address - Fax:951-486-5901
Practice Address - Street 1:26520 CACTUS AVE
Practice Address - Street 2:GME OFFICE ROOM A1005
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-3927
Practice Address - Country:US
Practice Address - Phone:951-486-5908
Practice Address - Fax:951-486-5901
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0102204489207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology