Provider Demographics
NPI:1841485489
Name:BRIAN DIEP MD INC
Entity type:Organization
Organization Name:BRIAN DIEP MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIEP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-488-7663
Mailing Address - Street 1:4892 E LA COSTA DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-7109
Mailing Address - Country:US
Mailing Address - Phone:619-865-1821
Mailing Address - Fax:
Practice Address - Street 1:2051 W WARNER RD
Practice Address - Street 2:STE # 5
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-2100
Practice Address - Country:US
Practice Address - Phone:626-488-7663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ261QP2300X261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ975831Medicaid
AZ975831Medicaid