Provider Demographics
NPI:1265716062
Name:SUEN, DIANE YAN
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:YAN
Last Name:SUEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 SALT LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95133-2066
Mailing Address - Country:US
Mailing Address - Phone:408-318-0136
Mailing Address - Fax:
Practice Address - Street 1:656 SALT LAKE DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95133-2066
Practice Address - Country:US
Practice Address - Phone:408-318-0136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26844390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program