Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 13444 | NV |
N | 111NI0900X | Internist | 13444 | NV |
N | 207R00000X | Internist | A111256 | CA |
N | 111NI0900X | Internist | A111256 | CA |
Y | 207RC0000X | Internist - Cardiovascular Disease | 13444 | NV |
N | 207RI0011X | Interventional Cardiology | 13444 | NV |
NPI | 1023132511 |
---|---|
Provider Name | Dr. Jimmy Diep |
First Address | Las Vegas, NV 89183-7518 |
Second Address | Las Vegas, NV 89119-5400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 30/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
13444 | NV MEDICAL LICENSE (01) | NV |
ASO2532199341 | DEA CERTIFICATE (01) | NV |
CS18484 | NV PHARMACY (01) | NV |
FD1858616 | DEA (01) | NV |
LL1738 | MEDICAL LICENSE (01) | NV |