Provider Demographics
NPI:1689236168
Name:LE, DIEM
Entity Type:Individual
Prefix:
First Name:DIEM
Middle Name:
Last Name:LE
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 1:8862 GARDEN GROVE BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-4204
Mailing Address - Country:US
Mailing Address - Phone:877-259-7577
Mailing Address - Fax:
Practice Address - Street 1:8862 GARDEN GROVE BLVD STE 206
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-4204
Practice Address - Country:US
Practice Address - Phone:877-259-7577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health