Provider Demographics
NPI:1851365688
Name:KAHLON, DIEM-THUY (DO)
Entity Type:Individual
Prefix:
First Name:DIEM-THUY
Middle Name:
Last Name:KAHLON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 E CAMELBACK RD STE 202
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2718
Mailing Address - Country:US
Mailing Address - Phone:602-229-2200
Mailing Address - Fax:
Practice Address - Street 1:2730 S VAL VISTA DR
Practice Address - Street 2:STE 152
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1675
Practice Address - Country:US
Practice Address - Phone:480-222-7664
Practice Address - Fax:480-222-7666
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3906207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ825945Medicaid
AZ825945Medicaid
H52131Medicare UPIN
AZZ147010Medicare PIN