Provider Demographics
NPI:1285382812
Name:DIEP, KIMBERLY AI
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:AI
Last Name:DIEP
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 1:8616 RIO DELL ST
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1142
Mailing Address - Country:US
Mailing Address - Phone:626-872-8221
Mailing Address - Fax:
Practice Address - Street 1:24167 PASEO DE VALENCIA
Practice Address - Street 2:
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637-3110
Practice Address - Country:US
Practice Address - Phone:949-586-3503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85165183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist