Provider Demographics
NPI:1972600856
Name:DINH, DINH VAN (DO)
Entity type:Individual
Prefix:DR
First Name:DINH
Middle Name:VAN
Last Name:DINH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14281 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-4567
Mailing Address - Country:US
Mailing Address - Phone:714-893-8800
Mailing Address - Fax:714-893-8810
Practice Address - Street 1:14281 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-4567
Practice Address - Country:US
Practice Address - Phone:714-893-8800
Practice Address - Fax:714-893-8810
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5768207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX5768Medicaid
E56141Medicare UPIN
CA00AX5768Medicaid