Provider Demographics
NPI:1184257891
Name:DIEP, DAN (DDS)
Entity type:Individual
Prefix:
First Name:DAN
Middle Name:
Last Name:DIEP
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6167 BRISTOL PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6616
Mailing Address - Country:US
Mailing Address - Phone:310-734-4547
Mailing Address - Fax:
Practice Address - Street 1:6167 BRISTOL PKWY STE 300
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6616
Practice Address - Country:US
Practice Address - Phone:310-734-4547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-20
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105713122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program