Provider Demographics
NPI:1962454652
Name:DIEP, DANIEL TRI (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:TRI
Last Name:DIEP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 W CHILDS AVE
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95341-6805
Mailing Address - Country:US
Mailing Address - Phone:209-383-1848
Mailing Address - Fax:209-384-3966
Practice Address - Street 1:2760 3RD ST
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-3235
Practice Address - Country:US
Practice Address - Phone:209-556-5011
Practice Address - Fax:209-556-5095
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91505207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA91505OtherMEDICAL LICENSE
CAA91505OtherMEDICAL LICENSE
CA00A915051Medicare PIN
CAA91505OtherMEDICAL LICENSE