Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC-27668 | CA |
NPI | 1548408412 |
---|---|
Provider Name | Dr. Lien Ai Diep |
First Address | Los Angeles, CA 90012-2309 |
Second Address | Los Angeles, CA 90012-2309 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2009 |
Last Update Date | 29/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U90136 | (02) | CA |