Provider Demographics
NPI:1750329702
Name:DIABLO VALLEY ENT - A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DIABLO VALLEY ENT - A MEDICAL CORPORATION
Other - Org Name:DIABLO VALLEY ENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:HSIEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-933-8462
Mailing Address - Street 1:1776 YGNACIO VALLEY RD
Mailing Address - Street 2:STE. 210
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3190
Mailing Address - Country:US
Mailing Address - Phone:925-933-8462
Mailing Address - Fax:925-933-4460
Practice Address - Street 1:1776 YGNACIO VALLEY RD
Practice Address - Street 2:STE. 210
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3190
Practice Address - Country:US
Practice Address - Phone:925-933-8462
Practice Address - Fax:925-933-4460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44211207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ37581ZMedicare ID - Type Unspecified