Provider Demographics
NPI:1871649897
Name:DIEP, CYNTHIA P (DDS)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:P
Last Name:DIEP
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2920 HUNTINGTON DR
Mailing Address - Street 2:SUITE 238
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2252
Mailing Address - Country:US
Mailing Address - Phone:626-286-9211
Mailing Address - Fax:626-286-9663
Practice Address - Street 1:2920 HUNTINGTON DR
Practice Address - Street 2:SUITE 238
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-2252
Practice Address - Country:US
Practice Address - Phone:626-286-9211
Practice Address - Fax:626-286-9663
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2012-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374101223G0001X
CA14984171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No171100000XOther Service ProvidersAcupuncturist