Provider Demographics
NPI:1972810547
Name:KOSHIMUNE, DIANE MIYE (DPM)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:MIYE
Last Name:KOSHIMUNE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 INTERNATIONAL CIR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1130
Mailing Address - Country:US
Mailing Address - Phone:408-972-6370
Mailing Address - Fax:408-972-6204
Practice Address - Street 1:270 INTERNATIONAL CIR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1130
Practice Address - Country:US
Practice Address - Phone:408-972-6370
Practice Address - Fax:408-972-6204
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4927213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE4927OtherCA DPM LICENSE
CAFV691ZOtherSO CA PTAN