Provider Demographics
NPI:1699198564
Name:LE, CAROLYN DIEMCHAU (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:DIEMCHAU
Last Name:LE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5915 HOLLIS ST STE B
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2066
Mailing Address - Country:US
Mailing Address - Phone:510-286-8160
Mailing Address - Fax:
Practice Address - Street 1:5915 HOLLIS ST STE B
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-2066
Practice Address - Country:US
Practice Address - Phone:510-286-8160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-29
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA140160207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine