Provider Demographics
NPI:1851496095
Name:DINHLUU, DIEMKHANH MARY (OD)
Entity type:Individual
Prefix:DR
First Name:DIEMKHANH
Middle Name:MARY
Last Name:DINHLUU
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:2111 VALLEJO DR
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-8618
Mailing Address - Country:US
Mailing Address - Phone:714-422-9921
Mailing Address - Fax:714-505-0079
Practice Address - Street 1:2414 S FAIRVIEW ST STE 103
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-5318
Practice Address - Country:US
Practice Address - Phone:714-557-9492
Practice Address - Fax:714-557-2548
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT100277PA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU58199Medicare UPIN
CF090YMedicare PIN